Individual
JYOTI B GANJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
80 B VETERANS BLVD, ACOMA, NM 87034
(505) 552-5300
(505) 552-5490
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
(505) 552-5300
(505) 552-5490
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
06964R
LA
208600000X
Surgery Physician
13972
AZ
208600000X
Surgery Physician
22011
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1979627
—
LA
05
—
H3451
—
NM
Enumeration date
10/04/2005
Last updated
11/23/2016
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