Provider Demographics
NPI:1285792465
Name:FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARFARAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-210-0040
Mailing Address - Street 1:3008 NW 168TH CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6787
Mailing Address - Country:US
Mailing Address - Phone:580-210-0040
Mailing Address - Fax:405-330-9082
Practice Address - Street 1:3008 NW 168TH CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6787
Practice Address - Country:US
Practice Address - Phone:580-210-0040
Practice Address - Fax:405-330-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200039780AMedicaid
OK200039780AMedicaid
OKG39067Medicare UPIN