Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 41123 | WI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD 00036974 | WA |
NPI | 1003904434 |
---|---|
Provider Name | Farouq A Al-Hamdan |
First Address | Mount Vernon, WA 98274-4114 |
Second Address | Mount Vernon, WA 98274-4114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 07/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0-456-828-3 | ECFMG (01) | |
34262200 | (05) | WI |
BA7912377 | DEA # (01) |