Basic Information
| Provider Information | |||||||||
| NPI: | 1063852655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | GHAZANFAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 732973 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753732973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177028450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 W EULESS BLVD | ||||||||
| Address2: | |||||||||
| City: | EULESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177021100 | ||||||||
| FaxNumber: | 8177021101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301102973 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Q9777 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.