Provider Demographics
NPI:1154370179
Name:FAROOQ, HASSAN (MD)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5669
Mailing Address - Country:US
Mailing Address - Phone:903-455-1234
Mailing Address - Fax:903-455-2122
Practice Address - Street 1:4812 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5669
Practice Address - Country:US
Practice Address - Phone:903-455-1234
Practice Address - Fax:903-455-2122
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10057137OtherAMERIGROUP
TX103580007Medicaid
TX110187668OtherRAILROAD MEDICARE
TXPARKLANDOtherPARKLAND HEALTHFIRST
TX10057137OtherAMERIGROUP
TXPARKLANDOtherPARKLAND HEALTHFIRST