1942205067 NPI number — GEORGE ANTOUN FARHAT MD

Table of content: GEORGE ANTOUN FARHAT MD (NPI 1942205067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942205067 NPI number — GEORGE ANTOUN FARHAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARHAT
Provider First Name:
GEORGE
Provider Middle Name:
ANTOUN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARHAT
Provider Other First Name:
GEORGES
Provider Other Middle Name:
ANTOUN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942205067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 780
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-868-1109
Provider Business Mailing Address Fax Number:
817-545-8266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 WEST BEDFORD-EULESS ROAD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-868-1109
Provider Business Practice Location Address Fax Number:
817-545-8266
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  J6944 , 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: 047450401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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