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General NPI Number Information
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NPI Number | 1003812595
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Entity Type | Individual
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Provider Name | NIRAN JAN AMAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 333 LONDONDERRY DR STE 100
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City | WACO
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State | TX
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Zip | 76712-7930
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Country | US
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Telephone | 254-751-1144
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Fax | 254-751-1185
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Provider Business Mailing Address
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Address Line | 333 LONDONDERRY DRIVE SUITE # 100
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City | WACO
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State | TX
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Zip | 76712
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Country | US
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Telephone | 254-751-1144
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Fax | 254-751-1185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KI0005X
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Taxonomy Name | Clinical & Laboratory Immunology (Allergy & Immunology) Physician
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License Number | G2305
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | G2305
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License Number State | TX
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