MEDICARE: ANNA JANELLE DENOOYER BROADNAX MD

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	207Q00000X	Family Medicine Physician	P8861	TX

General Provider Information

NPI Number	:	1366755944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA JANELLE DENOOYER BROADNAX MD

Provider Business Mailing Address
First Line	:	2201 LONG PRAIRIE RD STE 107-713
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	972-833-2163
Fax Number	:	972-833-2924

Provider Business Practice Location Address
First Line	:	2201 LONG PRAIRIE RD STE 107-713
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4832
Country	:	US
Telephone Number	:	972-833-2163
Fax Number	:	972-833-2924

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

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	06/17/2020

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