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General NPI Number Information
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NPI Number | 1629168562
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Entity Type | Organization
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Legal Business Name | ELIAS GHANDOUR, MD, PA
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3814 22ND PL
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City | LUBBOCK
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State | TX
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Zip | 79410-1118
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Country | US
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Telephone | 806-795-4500
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Fax | 806-795-4792
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Provider Business Mailing Address
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Address Line | 3814 22ND PL
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City | LUBBOCK
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State | TX
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Zip | 79410-1118
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Country | US
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Telephone | 806-795-4500
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Fax | 806-795-4792
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMMY L MCAULEY
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Credential |
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Telephone | 806-795-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H4930
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License Number State | TX
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