Provider Demographics
NPI:1821354598
Name:TAHA, FAROOK W
Entity Type:Individual
Prefix:
First Name:FAROOK
Middle Name:W
Last Name:TAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 FLOWING WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-9005
Mailing Address - Country:US
Mailing Address - Phone:845-518-4943
Mailing Address - Fax:
Practice Address - Street 1:1011 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2433
Practice Address - Country:US
Practice Address - Phone:214-320-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-07
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270821207P00000X
TXQ2072207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty