Provider Demographics
NPI:1043628696
Name:MAHMUD, ANAM (PA-C)
Entity type:Individual
Prefix:
First Name:ANAM
Middle Name:
Last Name:MAHMUD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S WATTERS RD
Mailing Address - Street 2:#915
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6515
Mailing Address - Country:US
Mailing Address - Phone:805-354-8388
Mailing Address - Fax:
Practice Address - Street 1:9901 ROYAL LN
Practice Address - Street 2:SUITE 106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1830
Practice Address - Country:US
Practice Address - Phone:805-354-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10144363AM0700X
VA0110004642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant