1467408021 NPI number — SARFARAZ ANWAR M.D

Table of content: SARFARAZ ANWAR M.D (NPI 1467408021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467408021 NPI number — SARFARAZ ANWAR M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANWAR
Provider First Name:
SARFARAZ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANWAR
Provider Other First Name:
SARFARAZ
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467408021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 NW 171ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73012-7415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-210-0040
Provider Business Mailing Address Fax Number:
405-330-9082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 NW 171ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73012-7415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-210-0040
Provider Business Practice Location Address Fax Number:
405-330-9082
Provider Enumeration Date:
05/25/2006

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: 207R00000X , with the licence number:  19859 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100008280B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".