Provider Demographics
NPI:1174535033
Name:GOPALANI, ANISA FARUK (MD)
Entity type:Individual
Prefix:
First Name:ANISA
Middle Name:FARUK
Last Name:GOPALANI
Suffix:
Gender:F
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 621004
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75262-1004
Mailing Address - Country:US
Mailing Address - Phone:936-756-3464
Mailing Address - Fax:936-703-5191
Practice Address - Street 1:133 MEDICAL PARK LN STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4979
Practice Address - Country:US
Practice Address - Phone:936-730-8833
Practice Address - Fax:936-730-8866
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00000208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185507401Medicaid
TX8G8287Medicare PIN