Provider Demographics
NPI:1790059848
Name:ABDUL S THANNOUN MD PA
Entity Type:Organization
Organization Name:ABDUL S THANNOUN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:THANNOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-354-2400
Mailing Address - Street 1:3501 SONCY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6405
Mailing Address - Country:US
Mailing Address - Phone:806-354-2400
Mailing Address - Fax:806-354-8070
Practice Address - Street 1:3501 SONCY RD STE 107
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-354-2400
Practice Address - Fax:806-354-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0308207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364174801Medicaid