Provider Demographics
NPI:1659319028
Name:FARIDI, AMIR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:ALI
Last Name:FARIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:5125 TEXOMA MEDICAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-0084
Practice Address - Country:US
Practice Address - Phone:903-868-4700
Practice Address - Fax:903-892-4910
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4420207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036240AMedicaid
TX122150908Medicaid
TX8R1436OtherBLUE CROSS OF TEXAS
TX8C0389Medicare PIN
OK200036240AMedicaid
TX8R1436OtherBLUE CROSS OF TEXAS