Provider Demographics
NPI:1003812595
Name:AMAR, NIRAN JAN (MD)
Entity Type:Individual
Prefix:
First Name:NIRAN
Middle Name:JAN
Last Name:AMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LONDONDERRY DRIVE SUITE # 100
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-751-1144
Mailing Address - Fax:254-751-1185
Practice Address - Street 1:333 LONDONDERRY DR
Practice Address - Street 2:STE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7930
Practice Address - Country:US
Practice Address - Phone:254-751-1144
Practice Address - Fax:254-751-1185
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2305207KI0005X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
19715OtherSCOTT & WHITE
107463100OtherFIRST CARE
TX88290YOtherBCBS
TX030001522OtherRAILROAD MEDICARE
TX100242002Medicaid
TX88290YOtherBCBS