# GHASSAN N. FANOUS, M.D. PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629262787
- **Authorized official:** MRS. KRISTI A MARTINEZ (OFFICE COORDINATOR)
- **Authorized official phone:** (432) 582-2280

## Contact information

- **Practice address:** 540 W 5TH ST, SUITE 420, ODESSA, TX 79761-5034
- **Practice address phone:** (432) 582-2280
- **Practice address fax:** (432) 331-9981
- **Mailing address:** 540 W 5TH ST, SUITE 420, ODESSA, TX 79761-5034
- **Mailing address phone:** (432) 582-2280
- **Mailing address fax:** (432) 331-9981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | J3306 | TX | Yes |

## Other

- **Enumeration date:** 08/31/2007
- **Last updated:** 03/24/2008