Provider Demographics
NPI:1174543698
Name:FARZAN, THAHIR (MD)
Entity type:Individual
Prefix:
First Name:THAHIR
Middle Name:
Last Name:FARZAN
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:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1300 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1745
Practice Address - Country:US
Practice Address - Phone:806-212-0699
Practice Address - Fax:806-212-0650
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3528207RC0200X, 207V00000X, 207VX0201X, 207VX0201X
NY238058207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325877401Medicaid
TX325877401Medicaid