Provider Demographics
NPI:1740243534
Name:JAMIL, FARRUKH (MD)
Entity type:Individual
Prefix:DR
First Name:FARRUKH
Middle Name:
Last Name:JAMIL
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 1:1007 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1195
Mailing Address - Country:US
Mailing Address - Phone:256-494-4000
Mailing Address - Fax:256-494-4474
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1195
Practice Address - Country:US
Practice Address - Phone:256-494-4000
Practice Address - Fax:256-494-4474
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL250322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-48317OtherAL BCBS
AL051518588Medicaid
AL1740243534 / 109108Medicaid
ALP00703796Medicare PIN
AL510-48317OtherAL BCBS
ALH96992Medicare UPIN
AL051518588Medicare PIN