1497730428 NPI number — DR. KHAWAJA N ANWAR MD

Table of content: DR. KHAWAJA N ANWAR MD (NPI 1497730428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497730428 NPI number — DR. KHAWAJA N ANWAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANWAR
Provider First Name:
KHAWAJA
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497730428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5012 S US HIGHWAY 75 STE 300
Provider Second Line Business Mailing Address:
ATTN. BILLING
Provider Business Mailing Address City Name:
DENISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75020-4589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-668-0333
Provider Business Mailing Address Fax Number:
940-668-0363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 HOSPITAL BLVD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-668-0333
Provider Business Practice Location Address Fax Number:
940-668-0363
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  G2307 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G2307 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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