Provider Demographics
NPI:1780610477
Name:ANTHONY, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ANTHONY
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 1:2100 HEDGCOXE DRIVE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3104
Mailing Address - Country:US
Mailing Address - Phone:972-801-3600
Mailing Address - Fax:972-801-3698
Practice Address - Street 1:2100 HEDGCOXE DRIVE, SUITE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3104
Practice Address - Country:US
Practice Address - Phone:972-801-3600
Practice Address - Fax:972-801-3698
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115707505Medicaid
TX115707504Medicaid
TXC12892Medicare UPIN
TX115707504Medicaid
TX115707505Medicaid