Provider Demographics
NPI:1114153301
Name:BACKLUND, AMANDA JANINE (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANINE
Last Name:BACKLUND
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 1:10709 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6153
Mailing Address - Country:US
Mailing Address - Phone:806-701-4040
Mailing Address - Fax:
Practice Address - Street 1:10709 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-6153
Practice Address - Country:US
Practice Address - Phone:806-701-4040
Practice Address - Fax:806-701-4041
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302791401Medicaid
TX8DJ848OtherMEDICARE
TXP01088460OtherRAILROAD MEDICARE
NM31981852Medicaid
TXTXB160090OtherMEDICARE