1699003053 NPI number — HAIDER AFZAL MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699003053 NPI number — HAIDER AFZAL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAIDER AFZAL MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAYTOWN FAMILY CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699003053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1682 WEST BAKER RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-428-8203
Provider Business Mailing Address Fax Number:
281-428-0624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1682 W BAKER RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-2286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-428-8203
Provider Business Practice Location Address Fax Number:
281-428-0624
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AFZAL
Authorized Official First Name:
HAIDER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-428-8203

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M3842 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 297617701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: B0147692 . This is a "DPS" identifier . This identifiers is of the category "OTHER".




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