Provider Demographics
NPI:1942205067
Name:FARHAT, GEORGE ANTOUN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANTOUN
Last Name:FARHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGES
Other - Middle Name:ANTOUN
Other - Last Name:FARHAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 780
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-868-1109
Mailing Address - Fax:817-545-8266
Practice Address - Street 1:729 WEST BEDFORD-EULESS ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-868-1109
Practice Address - Fax:817-545-8266
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6944207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047450401Medicaid
TX047450401Medicaid
G30769Medicare UPIN
TX8937K1Medicare ID - Type Unspecified