Provider Demographics
NPI:1134288277
Name:FARAG, AZMI E (MD)
Entity type:Individual
Prefix:DR
First Name:AZMI
Middle Name:E
Last Name:FARAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5390 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4062
Mailing Address - Country:US
Mailing Address - Phone:719-268-9000
Mailing Address - Fax:719-268-6687
Practice Address - Street 1:5390 N ACADEMY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4062
Practice Address - Country:US
Practice Address - Phone:719-268-9000
Practice Address - Fax:719-268-6687
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COFA29131OtherBLUE CROSS BLUE SHIELD
CO01305945Medicaid
COFA29131OtherBLUE CROSS BLUE SHIELD
C29131Medicare PIN