MEDICARE: JOE GHATA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	27952	OK
2	207RN0300X	Nephrology Physician	27952	OK

General Provider Information

NPI Number	:	1215258017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE GHATA MD

Provider Business Mailing Address
First Line	:	608 NW 9TH ST STE 4106
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1006
Country	:	US
Telephone Number	:	405-272-8367
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 NW 9TH ST STE 4106
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1006
Country	:	US
Telephone Number	:	405-272-8367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	12/05/2024

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