Provider Demographics
NPI:1881019537
Name:SOUTH OTOLARYNGOLOGY-HEAD AND NECK SURGERY, LLC
Entity Type:Organization
Organization Name:SOUTH OTOLARYNGOLOGY-HEAD AND NECK SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FARRAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-854-6019
Mailing Address - Street 1:2126 W ROY PARKER RD STE 207
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-8566
Mailing Address - Country:US
Mailing Address - Phone:334-443-0335
Mailing Address - Fax:
Practice Address - Street 1:2126 W ROY PARKER RD STE 207
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-8566
Practice Address - Country:US
Practice Address - Phone:334-443-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.32237207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty