Individual
EDWARD PANOUSIERIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2696 N GALLOWAY AVE, SUITE 102, MESQUITE, TX 75150
(972) 613-5500
(972) 613-5015
Mailing address
2696 N GALLOWAY AVE, SUITE 102, MESQUITE, TX 75150
(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
—
097269702
TPI
TX
05
—
097269702
—
TX
Enumeration date
08/31/2006
Last updated
07/22/2008
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