Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G2305 | TX |
NPI | 1003812595 |
---|---|
Provider Name | Niran Jan Amar |
First Address | Waco, TX 76712 |
Second Address | Waco, TX 76712-7930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030001522 | RAILROAD MEDICARE (01) | TX |
100242002 | (05) | TX |
107463100 | FIRST CARE (01) | |
19715 | SCOTT & WHITE (01) | |
88290Y | BCBS (01) | TX |