Provider Demographics
NPI:1841267010
Name:FARUQUI, IQBAL AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:IQBAL
Middle Name:AHMED
Last Name:FARUQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20454 NE FINLEY AVE
Mailing Address - Street 2:PO BOX 532
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-6012
Mailing Address - Country:US
Mailing Address - Phone:850-674-2221
Mailing Address - Fax:850-674-2121
Practice Address - Street 1:20454 NE FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-6012
Practice Address - Country:US
Practice Address - Phone:850-674-2221
Practice Address - Fax:850-674-2121
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371483700Medicaid
108963Medicare ID - Type Unspecified
FL371483700Medicaid