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Individual

GHASSAN N FANOUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
J3306
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
155882701
TX
Enumeration date
08/18/2006
Last updated
12/14/2011
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