Provider Demographics
NPI:1679571079
Name:PANJWANI, MAHMOOD B (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:B
Last Name:PANJWANI
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 1:3740 N JOSEY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2474
Mailing Address - Country:US
Mailing Address - Phone:214-731-0031
Mailing Address - Fax:214-731-0065
Practice Address - Street 1:3740 N JOSEY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2474
Practice Address - Country:US
Practice Address - Phone:214-731-0031
Practice Address - Fax:214-731-0065
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H1850OtherBCBS TX
TX131082307Medicaid
TX8A4913Medicare PIN
TX8H1850OtherBCBS TX