Provider Demographics
NPI:1356398762
Name:MUKHTAR ANEES M.D. P.A.
Entity type:Organization
Organization Name:MUKHTAR ANEES M.D. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKHTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-293-9292
Mailing Address - Street 1:701 E. RENDON-CROWLEY RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-293-9292
Mailing Address - Fax:817-551-0616
Practice Address - Street 1:701 E. RENDON-CROWLEY RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-293-9292
Practice Address - Fax:817-551-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180088001Medicaid
TXDD9505OtherMEDICARE RR
TXDD9505OtherMEDICARE RR