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General NPI Number Information
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NPI Number | 1174945729
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Entity Type | Organization
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Legal Business Name | EAST EL PASO ANESTHESIA GROUP PA
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 3909 N MESA ST STE 100
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City | EL PASO
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State | TX
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Zip | 79902-1501
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Country | US
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Telephone | 915-532-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 N MESA ST STE 122
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City | EL PASO
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State | TX
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Zip | 79902-1117
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Country | US
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Telephone | 915-219-4300
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Fax | 915-519-4300
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MARK GAN
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Credential | D.O.
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Telephone | 915-219-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G8120
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License Number State | TX
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