Provider Demographics
NPI:1336473453
Name:ANJUM, WAQAS (MD)
Entity type:Individual
Prefix:
First Name:WAQAS
Middle Name:
Last Name:ANJUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840857
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0857
Mailing Address - Country:US
Mailing Address - Phone:725-204-4632
Mailing Address - Fax:702-805-0307
Practice Address - Street 1:7160 RAFAEL RIVERA WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-5395
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:702-805-0307
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV25597207LC0200X, 207L00000X
PAMD4380402086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336473453Medicaid