Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | K7977 | TX |
N | 2081P2900X | Pain Medicine | K7977 | TX |
NPI | 1083635353 |
---|---|
Provider Name | Dr. Thiru Mandyam Annaswamy |
First Address | Dallas, TX 75216-7167 |
Second Address | Dallas, TX 75216-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G98261 | (02) | TX |