Healthcare Provider Details

I. General information

NPI: 1376066290
Provider Name (Legal Business Name): MUHAMMAD FAZEEL ANWAR MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 INNOVATION CT STE A
GRAY LA
70359-3131
US

IV. Provider business mailing address

1160 MALL DR
LAS CRUCES NM
88011-8128
US

V. Phone/Fax

Practice location:
  • Phone: 985-303-4100
  • Fax:
Mailing address:
  • Phone: 575-521-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2024-0512
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number352945
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: