Provider Demographics
NPI:1639303308
Name:HUSAIN, FARAH (PAC)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:214-350-9334
Mailing Address - Fax:214-387-7798
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 209
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:214-350-9334
Practice Address - Fax:214-387-7798
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L15427Medicare PIN
TX8L15403Medicare PIN
TX8L15428Medicare PIN