Provider Demographics
NPI:1659448793
Name:ANDUJAR, AMY (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ANDUJAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 LAKEVIEW PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4560
Mailing Address - Country:US
Mailing Address - Phone:972-475-5598
Mailing Address - Fax:972-463-2321
Practice Address - Street 1:9500 LAKEVIEW PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4560
Practice Address - Country:US
Practice Address - Phone:972-475-5598
Practice Address - Fax:972-463-2321
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01017363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB155113Medicare PIN
TXQ37836Medicare UPIN