Organization
EDWARD PANOUSIERIS, DOPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD PANOUSIERIS D.O. (PHYSICIAN/OWNER)
(972) 613-5500
Entity
Organization
Contact information
Practice address
2696 N GALLOWAY AVE, SUITE 102, MESQUITE, TX 75150-6362
(972) 613-5500
(972) 613-5015
Mailing address
2696 N GALLOWAY AVE, SUITE 102, MESQUITE, TX 75150-6362
(972) 613-5500
(972) 613-5015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H2665
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A67K
MEDICARE ID
TX
01
—
097269702
TPI
—
Enumeration date
08/05/2013
Last updated
08/05/2013
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