=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033118872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAHMOOD B. PANJWANI M.D, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2005
-----------------------------------------------------
Last Update Date | 08/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3740 N JOSEY LN SUITE 206
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-2474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-731-0031
-----------------------------------------------------
Fax | 214-731-0065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3740 N JOSEY LN SUITE 206
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-2474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-731-0031
-----------------------------------------------------
Fax | 214-731-0065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MAHMOOD B PANJWANI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-731-0031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | J6200
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------