Provider Demographics
NPI:1831584689
Name:ISAACS, ANNA O'MELIA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:O'MELIA
Last Name:ISAACS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:O'MELIA
Other - Last Name:GLOWACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 SOUTH 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014
Mailing Address - Country:US
Mailing Address - Phone:806-323-8882
Mailing Address - Fax:806-323-6108
Practice Address - Street 1:1010 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014
Practice Address - Country:US
Practice Address - Phone:806-323-8882
Practice Address - Fax:806-323-6108
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2132207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3756587Medicaid