Provider Demographics
NPI:1639286339
Name:GHALI, FRED ELIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:ELIAS
Last Name:GHALI
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 1:1325 W. NORTHWEST HWY.
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7524
Mailing Address - Country:US
Mailing Address - Phone:817-421-3376
Mailing Address - Fax:817-416-4269
Practice Address - Street 1:1325 W. NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7524
Practice Address - Country:US
Practice Address - Phone:817-421-3376
Practice Address - Fax:817-416-4269
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0033GUOtherBCBS OF TEXAS
TX1899683OtherUNITED HEALTHCARE
TX7267016OtherAETNA
TX0033GUOtherBCBS OF TEXAS