Provider Demographics
NPI:1548322001
Name:AHMED, ANISA (MD)
Entity type:Individual
Prefix:DR
First Name:ANISA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 SPECTRUM BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-9705
Mailing Address - Country:US
Mailing Address - Phone:972-231-6564
Mailing Address - Fax:972-231-0360
Practice Address - Street 1:3409 SPECTRUM BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9705
Practice Address - Country:US
Practice Address - Phone:972-231-6564
Practice Address - Fax:972-231-0360
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200613201Medicaid