Individual
MUHAMMAD ANIS MEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 E BROAD ST, SUITE 204, MANSFIELD, TX 76063-6409
(817) 477-5500
(817) 453-5503
Mailing address
2800 E BROAD ST, SUITE 204, MANSFIELD, TX 76063-6409
(817) 477-5500
(817) 453-5503
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
M1931
TX
207RG0100X
Gastroenterology Physician
Primary
154192
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001NA
BCBS
TX
05
—
180095501
—
TX
01
—
5915477
AETNA
TX
01
—
P00262265
MEDICARE RR
TX
Enumeration date
08/01/2006
Last updated
09/24/2014
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