Basic Information
| Provider Information | |||||||||
| NPI: | 1184010597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACK | ||||||||
| FirstName: | ANWAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 SIERRA ROSE DRIVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756895410 | ||||||||
| FaxNumber: | 7754511713 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 SIERRA ROSE DRIVE #4 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756895410 | ||||||||
| FaxNumber: | 7757864031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME133682 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207R00000X | TRN21142 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208VP0000X | ME133682 | FL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207LP2900X | 19872 | NV | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.