| Edward Panousieris, Dopa | |
|
2696 N Galloway Ave Suite 102 Mesquite TX 75150-6362 | |
| (972) 613-5500 | |
| (972) 613-5015 |
| Full Name | Edward Panousieris, Dopa |
|---|---|
| Speciality | Family Medicine |
| Location | 2696 N Galloway Ave, Mesquite, Texas |
| Authorized Official Name and Position | Edward Panousieris (PHYSICIAN/OWNER) |
| Authorized Official Contact | 9726135500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward Panousieris, Dopa 2696 N Galloway Ave Suite 102 Mesquite TX 75150-6362 Ph: (972) 613-5500 | Edward Panousieris, Dopa 2696 N Galloway Ave Suite 102 Mesquite TX 75150-6362 Ph: (972) 613-5500 |
| NPI Number | 1144652900 |
|---|---|
| Provider Enumeration Date | 08/05/2013 |
| Last Update Date | 08/05/2013 |
| Medicare PECOS PAC ID | 1759523343 |
|---|---|
| Medicare Enrollment ID | O20130812000002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144652900 | NPI | - | NPPES |
| 097269702 | Other | TPI | |
| 00A67K | Other | TX | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H2665 (Texas) | Primary |
| Provider Name | Edward Panousieris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578675864 PECOS PAC ID: 5799830998 Enrollment ID: I20130812000286 |
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