Provider Demographics
NPI:1518196930
Name:IMRAN FAYAZ, M.D., P.A.
Entity Type:Organization
Organization Name:IMRAN FAYAZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-779-4030
Mailing Address - Street 1:PO BOX 131479
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-1479
Mailing Address - Country:US
Mailing Address - Phone:281-779-4030
Mailing Address - Fax:281-419-9997
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 222
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2800
Practice Address - Country:US
Practice Address - Phone:281-779-4030
Practice Address - Fax:281-419-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1090207T00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty