Provider Demographics
NPI:1033118872
Name:MAHMOOD B. PANJWANI M.D, P.A.
Entity type:Organization
Organization Name:MAHMOOD B. PANJWANI M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:B
Authorized Official - Last Name:PANJWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-731-0031
Mailing Address - Street 1:3740 N JOSEY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2474
Mailing Address - Country:US
Mailing Address - Phone:214-731-0031
Mailing Address - Fax:214-731-0065
Practice Address - Street 1:3740 N JOSEY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2474
Practice Address - Country:US
Practice Address - Phone:214-731-0031
Practice Address - Fax:214-731-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048JQOtherBCBS TX
TX131082307Medicaid
TX0048JQOtherBCBS TX
G17099Medicare UPIN