| Name: | Farouk A. Raquib, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 09 Jun 1994 (30 years ago) |
| Entity Number: | 000-164-654 |
| Register Number: | 000164654 |
| County: | Lamar |
| Place of Formation: | Fayette County |
| Principal Address: | VERNON, AL |
| Registered Office Street Address: | RT 1 BOX 362-DVERNON, AL 35592 |
| Registered Office Street Address ZIP Code: | 35592 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
TO PRACTICE THE PROFESSION OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760531479 | 2007-01-10 | 2024-04-11 | PO BOX 1140, WINFIELD, AL, 355941140, US | 125 BOB LAWRENCE DRIVE, WINFIELD, AL, 355945120, US | |||||||||||||||||||||||||
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| Phone | +1 205-487-4535 |
| Fax | 2054878827 |
Authorized person
| Name | FAROUK RAQUIB |
| Role | PHYSICIAN |
| Phone | 2054874535 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 16185 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000032921 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| RAQUIB, FAROUK A | Agent | 390 MEDICAL DRIVEWINFIELD, AL 35594 |
| Name | Role | Address |
|---|---|---|
| RAQUIB, FAROUK A | Incorporator | 390 MEDICAL DRIVEWINFIELD, AL 35594 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
