Provider Demographics
NPI:1699913038
Name:NORTH TEXAS GASTROINTESTINAL ASSOCIATES PA
Entity type:Organization
Organization Name:NORTH TEXAS GASTROINTESTINAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-566-4720
Mailing Address - Street 1:2501 SCRIPTURE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2313
Mailing Address - Country:US
Mailing Address - Phone:940-566-4720
Mailing Address - Fax:940-566-4727
Practice Address - Street 1:2501 SCRIPTURE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2313
Practice Address - Country:US
Practice Address - Phone:940-566-4720
Practice Address - Fax:940-566-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202446501Medicaid
TX0021SDOtherBCBS
TX0021SDOtherBCBS