Provider Demographics
NPI:1619074721
Name:FAZAL, BARKAT ALI (MD, MPHTM)
Entity Type:Individual
Prefix:
First Name:BARKAT
Middle Name:ALI
Last Name:FAZAL
Suffix:
Gender:M
Credentials:MD, MPHTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16659 SOUTHWEST FWY STE 371
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2375
Mailing Address - Country:US
Mailing Address - Phone:718-960-1281
Mailing Address - Fax:281-265-1240
Practice Address - Street 1:16659 SOUTHWEST FREEWAY
Practice Address - Street 2:MOB 2, SUITE 371
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-265-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0901207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE19149Medicare UPIN