Provider Demographics
NPI:1205499175
Name:FAZAL AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:FAZAL AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-791-6115
Mailing Address - Street 1:150 FALCON CREST CT
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1432
Mailing Address - Country:US
Mailing Address - Phone:606-791-6115
Mailing Address - Fax:
Practice Address - Street 1:255 CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3499
Practice Address - Country:US
Practice Address - Phone:606-791-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty