Provider Demographics
NPI:1053314401
Name:ANWAR, SYED IMTIAZ (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:IMTIAZ
Last Name:ANWAR
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 1:2929 CALDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-833-9797
Mailing Address - Fax:409-839-3174
Practice Address - Street 1:3570 COLLEGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4683
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-654-6803
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044476201Medicaid
TXG47090Medicare UPIN
TX85X136Medicare PIN
TX044476201Medicaid