Provider Demographics
NPI:1467097105
Name:MAHMUD, RACHEL ANDERSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANDERSON
Last Name:MAHMUD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:JOAN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:821 E INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6745
Mailing Address - Country:US
Mailing Address - Phone:817-596-4313
Mailing Address - Fax:817-341-2394
Practice Address - Street 1:821 E INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6745
Practice Address - Country:US
Practice Address - Phone:817-596-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13029363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant