Individual
AMARANATH GHANTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.,FCCP,D,ABSM
Contact information
Practice address
600 N WASHINGTON AVE, ODESSA, TX 79761-4436
(432) 337-5223
(432) 333-5159
Mailing address
600 N WASHINGTON AVE, ODESSA, TX 79761-4436
(432) 337-5223
(432) 333-5159
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H8654
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0095CL
BLUE CROSS BLUE SHIELD
TX
01
—
J3115
MEDICAID NEW MEXICO
NM
Enumeration date
09/09/2005
Last updated
07/08/2007
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