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Referring Provider Fax
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Diagnosis
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Patient Name
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First Name
Last Name
DOB
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Phone Number
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Area Code
Phone Number
Primary Language
English
Spanish
Other
Gender
Male
Female
Location
Next Available
Amarillo (Habib/Mantry/Nazario)
Bedford (Weinstein)
Dallas (All)
Fort Worth (Nazario/Habib/Mehta)
Lubbock (Barnes/Mantry/Weinstein)
Mansfield (Habib/Pagadala)
McKinney (Vahora)
Midland (Pagadala/Vahora)
Plano (Barnes/Mantry/Nazario)
Richardson (Mantry/Vahora)
Tyler (Barnes/Mantry/Mehta/Pagadala)
Physicians
Next Available
Maisha Barnes, M.D.
Adil Habib, M.D.
Parvez Mantry, M.D.
Ashwini Mehta, D.O.
Hector Nazario, M.D.
Mangesh Pagadala, M.D.
Zahid Vahora, M.D.
Jeffrey Weinstein, M.D.
Edward Dominguez, M.D.- Infectious Disease
Surgeons
Next Available
Richard Dickerman, M.D.
Carlos Fasola, M.D.
Lori Kautzman M.D.
Alejandro Mejia, M.D.
Vichin Puri, M.D.
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