Individual
ALAA BOU GHANNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13001 E 17TH PL, AURORA, CO 80045-2570
(303) 724-5000
Mailing address
2131 LAWRENCE ST APT 606, DENVER, CO 80205-2896
(202) 531-5858
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0116028520
VA
207W00000X
Ophthalmology Physician
MTL002799
DC
207W00000X
Ophthalmology Physician
Primary
TL.0005920
CO
Other
Enumeration date
07/23/2015
Last updated
06/30/2016
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