Provider Demographics
NPI:1831687755
Name:GHANIM, DAFFER (MD)
Entity type:Individual
Prefix:DR
First Name:DAFFER
Middle Name:
Last Name:GHANIM
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 1:3055 ROSLYN STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238
Mailing Address - Country:US
Mailing Address - Phone:720-553-2696
Mailing Address - Fax:720-848-9050
Practice Address - Street 1:3055 ROSLYN STREET
Practice Address - Street 2:SUITE #100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238
Practice Address - Country:US
Practice Address - Phone:720-553-2696
Practice Address - Fax:720-848-9050
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-12-10
Deactivation Date:2018-11-29
Deactivation Code:
Reactivation Date:2018-12-10
Provider Licenses
StateLicense IDTaxonomies
COTL.0007036390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program