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General NPI Number Information
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NPI Number | 1831458132
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Entity Type | Organization
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Legal Business Name | CENTENNIAL PRIMARY CARE PLLC
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 07/21/2012
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Provider Practice Location Address
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Address Line | 5520 INDEPENDENCE PKWY SUITE 201
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City | FRISCO
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State | TX
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Zip | 75035-4606
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Country | US
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Telephone | 214-383-0001
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Fax | 214-383-0068
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Provider Business Mailing Address
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Address Line | 5520 INDEPENDENCE PKWY SUITE 201
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City | FRISCO
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State | TX
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Zip | 75035-4606
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Country | US
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Telephone | 214-383-0001
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Fax | 214-383-0068
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | NUZHAT F AHMED
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Credential | MD
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Telephone | 512-656-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K3664
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License Number State | TX
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