Provider Demographics
NPI:1538132915
Name:ANSARI, ANIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIS
Middle Name:A
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E HEBRON PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1525
Mailing Address - Country:US
Mailing Address - Phone:972-939-4646
Mailing Address - Fax:972-939-6161
Practice Address - Street 1:1948 E HEBRON PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1525
Practice Address - Country:US
Practice Address - Phone:972-939-4646
Practice Address - Fax:972-939-6161
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126997907Medicaid
TX020327201Medicaid
TXF88489Medicare UPIN
TX020327201Medicaid