Basic Information
| Provider Information | |||||||||
| NPI: | 1568653939 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | M AFTAB ANWAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3704 BEINVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288180563 | ||||||||
| FaxNumber: | 2288180519 | ||||||||
| Practice Location | |||||||||
| Address1: | 3704 BEINVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288180563 | ||||||||
| FaxNumber: | 2288180519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 08/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | ANWAR | ||||||||
| AuthorizedOfficialFirstName: | AFTAB | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2288180563 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 12803 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 09357025 | 05 | MS | MEDICAID |