Provider Demographics
NPI:1669647376
Name:GANESH, ALLAN SEBASTIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:SEBASTIAN
Last Name:GANESH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 SWIFT WATER DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-8170
Mailing Address - Country:US
Mailing Address - Phone:267-259-1786
Mailing Address - Fax:
Practice Address - Street 1:6200 REGIONAL PLZ
Practice Address - Street 2:SUITE# 1450
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5250
Practice Address - Country:US
Practice Address - Phone:325-480-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3274213ES0103X
TX1862213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW296OtherBLUE CROSS BLUE SHIELD PROVIDER #
TXP00677666OtherRAIL ROAD MEDICARE GROUP MEMBER PTAN
TX195625201Medicaid
TX195625201Medicaid