NPIMap

Organization Active NPI

4500 Gulfway Medical Management PA

  • Physician Assistant
  • Port Arthur, TX
National Provider Identifier
1326100439
Registry record updated Oct 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
D5588 Issued in TX
Legal business name
4500 GULFWAY MEDICAL MANAGEMENT PA
Practice address
4500 Gulfway Drive
Port Arthur, TX 77642
Phone
(409) 982-5110
Fax
(409) 982-8196
NPI assigned
Dec 14, 2006
Last updated
Oct 29, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Isam Nazmi Anabtawi, MD
Title
Doctor
Phone
(409) 982-5110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X D5588 TX Primary

Addresses

Primary practice location

4500 Gulfway Drive
Port Arthur, TX 77642

Mailing address

PO Box 3756
Port Arthur, TX 77643
Phone (409) 982-5110

National Provider Directory

National Provider Directory

Locations

4500 Gulfway Dr
Port Arthur, TX 77642
Phone (409) 982-5110

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1326100439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3756",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "77643",
            "telephone_number": "409-982-5110",
            "fax_number": "409-982-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 GULFWAY DRIVE",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "77642",
            "telephone_number": "409-982-5110",
            "fax_number": "409-982-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4500 GULFWAY MEDICAL MANAGEMENT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "ANABTAWI",
        "authorized_official_first_name": "ISAM",
        "authorized_official_middle_name": "NAZMI",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "409-982-5110",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "D5588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Arthur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.