Provider Demographics
NPI:1932165362
Name:RAZAK, BRIAN WAYNE (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WAYNE
Last Name:RAZAK
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2307
Mailing Address - Country:US
Mailing Address - Phone:785-650-4647
Mailing Address - Fax:
Practice Address - Street 1:600 PARK ST
Practice Address - Street 2:FORT HAYS STATE UNIVERSITY
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4009
Practice Address - Country:US
Practice Address - Phone:785-628-5823
Practice Address - Fax:785-628-4383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-00058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist