Healthcare Provider Details

I. General information

NPI: 1619979473
Provider Name (Legal Business Name): MUHAMMAD SUBHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 WALLACE BLVD ATTN: CREDENTIALING DEPT.
AMARILLO TX
79106-1708
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-5630
  • Fax: 806-354-5689
Mailing address:
  • Phone: 806-354-5585
  • Fax: 806-356-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number234458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: