Provider Demographics
NPI:1255375531
Name:DHAM, ANU (MD)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:DHAM
Suffix:
Gender:F
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1200 BROOKLYN AVE
Practice Address - Street 2:SUITE #115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4803
Practice Address - Country:US
Practice Address - Phone:210-242-6531
Practice Address - Fax:210-226-0402
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6104207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AA842OtherBLUECROSS/BLUESHIELD TX.
TX185606402Medicaid
TX185606401Medicaid
TXP01547656OtherRAILROAD MEDICARE
TX185606401Medicaid
TX436842YKYCMedicare PIN
TXP00437217Medicare PIN
TX8AA842OtherBLUECROSS/BLUESHIELD TX.
TXP01547656OtherRAILROAD MEDICARE