# EDWARD PANOUSIERIS, DOPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144652900
- **Authorized official:** EDWARD PANOUSIERIS D.O. (PHYSICIAN/OWNER)
- **Authorized official phone:** (972) 613-5500

## Contact information

- **Practice address:** 2696 N GALLOWAY AVE, SUITE 102, MESQUITE, TX 75150-6362
- **Practice address phone:** (972) 613-5500
- **Practice address fax:** (972) 613-5015
- **Mailing address:** 2696 N GALLOWAY AVE, SUITE 102, MESQUITE, TX 75150-6362
- **Mailing address phone:** (972) 613-5500
- **Mailing address fax:** (972) 613-5015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | H2665 | TX | Yes |

## Other

- **Enumeration date:** 08/05/2013
- **Last updated:** 08/05/2013