Healthcare Provider Details

I. General information

NPI: 1831417039
Provider Name (Legal Business Name): ANUJ TEWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N INTERSTATE 35
DENTON TX
76201-5119
US

IV. Provider business mailing address

3000 N INTERSTATE 35
DENTON TX
76201-5119
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60389136
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ2077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: