Individual
FAZLE MATIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
203 WEST LEE STREET, TUSKEGEE, AL 36083
(334) 727-7050
(334) 727-6284
Mailing address
203 WEST LEE STREET, TUSKEGEE, AL 36083
(334) 727-7050
(334) 727-6284
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
00022310
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51005213
BC
AL
05
—
631000021
—
AL
Enumeration date
02/09/2007
Last updated
07/08/2007
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