Provider Demographics
NPI:1942288105
Name:GHANBARI, HOSSEIN (MD)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:GHANBARI
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 1:1921 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4129
Mailing Address - Country:US
Mailing Address - Phone:940-723-2229
Mailing Address - Fax:940-723-2233
Practice Address - Street 1:1921 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4129
Practice Address - Country:US
Practice Address - Phone:940-723-2229
Practice Address - Fax:940-723-2233
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6299207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128263407Medicaid
TXA83679Medicare UPIN
TX128263407Medicaid