Healthcare Provider Details

I. General information

NPI: 1982913299
Provider Name (Legal Business Name): PAUL JOHN GHATTAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 WARREN PKWY STE 200
FRISCO TX
75034-7398
US

IV. Provider business mailing address

PO BOX 207447
DALLAS TX
75320-7447
US

V. Phone/Fax

Practice location:
  • Phone: 469-850-0680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberQ3875
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: