Provider Demographics
NPI:1487653820
Name:IJAZ, FAKHAR (MD)
Entity Type:Individual
Prefix:
First Name:FAKHAR
Middle Name:
Last Name:IJAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 508
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5306
Mailing Address - Country:US
Mailing Address - Phone:501-588-1100
Mailing Address - Fax:501-588-1750
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-588-1100
Practice Address - Fax:501-588-1750
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5200207R00000X
ARE4531207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158903001Medicaid
TX1592743-05Medicaid
TX8B6021Medicare PIN
TXG79245Medicare UPIN
5N391Medicare PIN
G79245Medicare UPIN
TX1592743-05Medicaid