MEDICARE: MAHMOOD B. PANJWANI M.D, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J6200	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0048JQ	OTHER	TX	BCBS TX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033118872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHMOOD B. PANJWANI M.D, P.A.

Provider Business Mailing Address
First Line	:	3740 N JOSEY LN
Second Line	:	SUITE 206
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2474
Country	:	US
Telephone Number	:	214-731-0031
Fax Number	:	214-731-0065

Provider Business Practice Location Address
First Line	:	3740 N JOSEY LN
Second Line	:	SUITE 206
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2474
Country	:	US
Telephone Number	:	214-731-0031
Fax Number	:	214-731-0065

Authorized Official
Title or Position	:	OWNER
Name	:	MAHMOOD B PANJWANI
Credential	:	M.D.
Telephone Number	:	214-731-0031

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/28/2012

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