Individual
AMANDA JANINE BACKLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10709 MILWAUKEE AVE, LUBBOCK, TX 79424-6153
(806) 701-4040
(806) 701-4041
Mailing address
10709 MILWAUKEE AVE, LUBBOCK, TX 79424-6153
(806) 701-4040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
P2950
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302791401
—
TX
05
—
31981852
—
NM
01
—
8DJ848
MEDICARE
TX
01
—
P01088460
RAILROAD MEDICARE
TX
01
—
TXB160090
MEDICARE
TX
Enumeration date
06/02/2009
Last updated
01/16/2024
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