MEDICARE: DR. MAMMO AMARE M.D.

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	207RX0202X	Medical Oncology Physician	J4692	TX
2	207RH0003X	Hematology & Oncology Physician	J4692	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8R1383	OTHER	TX	BLUE CROSS OF TEXAS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225076862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAMMO AMARE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-437-9605

Provider Business Practice Location Address
First Line	:	3555 W WHEATLAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3461
Country	:	US
Telephone Number	:	972-709-2580
Fax Number	:	972-298-6485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	03/06/2008

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