Provider Demographics
NPI:1952585697
Name:H GHANBARI MD PA
Entity Type:Organization
Organization Name:H GHANBARI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANBARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-723-2229
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189022001Medicaid
TX189022001Medicaid