Provider Demographics
NPI:1164502753
Name:NAZRE MAWLA MD PA
Entity Type:Organization
Organization Name:NAZRE MAWLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:NAZRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-358-1671
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-358-1671
Mailing Address - Fax:806-358-0168
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-358-1671
Practice Address - Fax:806-358-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1103208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023SJOtherBLUE CROSS BLUE SHIELD GROUP RECORD
TXP00721322OtherRAILROAD MEDICARE MEMBER PTAN
TX208005301Medicaid
TXDO6645OtherRAILROAD MEDICARE GROUP PTAN
TX118791100OtherFIRSTCARE
TX8BF273OtherBLUE CROSS BLUE SHIELD DR. RECORD
TXDO6645OtherRAILROAD MEDICARE GROUP PTAN
TXB24678Medicare UPIN