=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114931045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KASHIF ANWAR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 11/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 N FIELDER RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76012-4636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-460-7911
-----------------------------------------------------
Fax | 817-460-5485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 203032
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-9132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-460-7911
-----------------------------------------------------
Fax | 817-460-5485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 19379
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | N8606
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------