Provider Demographics
NPI:1073578753
Name:AWAN, AMJAD NAEEM (MD)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:NAEEM
Last Name:AWAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 COLORADO BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6877
Mailing Address - Country:US
Mailing Address - Phone:940-231-1632
Mailing Address - Fax:
Practice Address - Street 1:3304 COLORADO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6877
Practice Address - Country:US
Practice Address - Phone:940-231-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0098089207RG0100X
TXK9017207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141655403Medicaid
TX100015845OtherRAIL ROAD MEDICARE INDIVIDUAL
TX141655405Medicaid
TX219119901Medicaid
TX141655404Medicaid
TX8G0100OtherBC/BS
TX141655402Medicaid
TX8F7469Medicare PIN
TX219119901Medicaid
TX141655404Medicaid
TX141655405Medicaid
TX219119901Medicaid
TX141655404Medicaid
TX141655405Medicaid