Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | J3514 | TX |
NPI | 1114964756 |
---|---|
Provider Name | Dr. Pankaj Khandelwal |
First Address | Dallas, TX 75391-1230 |
Second Address | Odessa, TX 79761-5413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 29/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000J7105 | (05) | NM |
135931701 | (05) | TX |
135931702 | (05) | TX |
135931703 | (05) | TX |
135931704 | (05) | TX |
135931705 | (05) | TX |
135931706 | (05) | TX |
135931709 | (05) | TX |
830001029 | RAILROAD (01) | TX |
8R1486 | BLUE CROSS TX (01) | TX |
F60253 | (02) |