Provider Demographics
NPI:1326488362
Name:DOSSUL, AMENA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMENA
Middle Name:
Last Name:DOSSUL
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 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:512-686-0127
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:3950 N A W GRIMES BLVD STE N201
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3540
Practice Address - Country:US
Practice Address - Phone:512-524-9282
Practice Address - Fax:512-218-0515
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
TXQ6316208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program