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General NPI Number Information
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NPI Number | 1487612727
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Entity Type | Organization
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Legal Business Name | GHANEM DAGHESTANI MD PA
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 2717 MICHAEL ANGELO SUITE 303
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City | EDINBURG
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State | TX
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Zip | 78539-1408
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Country | US
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Telephone | 956-687-4600
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Fax | 956-631-4555
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Provider Business Mailing Address
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Address Line | PO BOX 1348
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City | EDINBURG
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State | TX
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Zip | 78540-1348
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Country | US
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Telephone | 956-687-4600
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Fax | 956-631-4555
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | GHANEM DAGHESTANI
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Credential | MD
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Telephone | 956-542-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | NULL
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