Provider Demographics
NPI:1700294618
Name:WAHID, FAZAL NOUMAN (MD)
Entity Type:Individual
Prefix:
First Name:FAZAL NOUMAN
Middle Name:
Last Name:WAHID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 E.17TH PLACE
Mailing Address - Street 2:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2581
Mailing Address - Country:US
Mailing Address - Phone:720-777-5506
Mailing Address - Fax:
Practice Address - Street 1:13001 E.17TH PLACE
Practice Address - Street 2:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2581
Practice Address - Country:US
Practice Address - Phone:720-777-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5411390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program