Provider Demographics
NPI:1063458230
Name:DHAWAN, JASBIR (MD)
Entity Type:Individual
Prefix:
First Name:JASBIR
Middle Name:
Last Name:DHAWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14725 LEBANON ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:214-705-9000
Mailing Address - Fax:214-619-5675
Practice Address - Street 1:14725 LEBANON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:214-705-9000
Practice Address - Fax:214-619-5675
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010856207R00000X
TXN0729207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100413460BMedicaid
MO143561OtherANTHEM
MO2087666303Medicaid
OK100053530AMedicaid
P00116533OtherRR MEDICARE
OK100053530AMedicaid
MO920043564Medicare PIN