Provider Demographics
NPI:1619273125
Name:ABULBASHER M FAIZULLAH MD PA
Entity Type:Organization
Organization Name:ABULBASHER M FAIZULLAH MD PA
Other - Org Name:EMERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ABULBASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIZULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-699-5111
Mailing Address - Street 1:1816 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-6407
Mailing Address - Country:US
Mailing Address - Phone:432-699-5111
Mailing Address - Fax:432-699-0773
Practice Address - Street 1:1816 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6407
Practice Address - Country:US
Practice Address - Phone:432-699-5111
Practice Address - Fax:432-699-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty