Provider Demographics
NPI:1558587519
Name:PANA, ANDREA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LOUISE
Last Name:PANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:360 NUECES ST
Mailing Address - Street 2:#1105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4195
Mailing Address - Country:US
Mailing Address - Phone:512-203-8940
Mailing Address - Fax:
Practice Address - Street 1:2012 ROBERT DEDMAN DRIVE
Practice Address - Street 2:MNC 1.218
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-471-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1285207QS0010X
CAG74916207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG90544Medicare UPIN