Provider Demographics
NPI:1073578753
Name:AWAN, AMJAD NAEEM (MD)
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:NAEEM
Last Name:AWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 N DENTON TAP RD
Mailing Address - Street 2:210-352
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2138
Mailing Address - Country:US
Mailing Address - Phone:940-243-0912
Mailing Address - Fax:940-243-0921
Practice Address - Street 1:3323 COLORADO BLVD
Practice Address - Street 2:STE. 105
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6895
Practice Address - Country:US
Practice Address - Phone:940-243-0912
Practice Address - Fax:940-243-0921
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9017207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141655405Medicaid
TX141655404Medicaid
TX141655402Medicaid
TX141655403Medicaid
TX219119901Medicaid
TX8G0100OtherBC/BS
TX100015845OtherRAIL ROAD MEDICARE INDIVIDUAL
TX8F7469Medicare PIN
TX219119901Medicaid
TX141655404Medicaid
TX141655405Medicaid
TX219119901Medicaid
TX141655404Medicaid
TX141655405Medicaid