Healthcare Provider Details

I. General information

NPI: 1639286339
Provider Name (Legal Business Name): FRED ELIAS GHALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W NORTHWEST HWY
GRAPEVINE TX
76051-3141
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 500
DALLAS TX
75231-0928
US

V. Phone/Fax

Practice location:
  • Phone: 817-421-3376
  • Fax: 817-416-4269
Mailing address:
  • Phone: 214-987-3376
  • Fax: 469-532-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberJ7330
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberJ7330
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: