Provider Demographics
NPI:1699719138
Name:GHANDOUR, ELIAS (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:GHANDOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4515 MARSHA SHARP FWY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2520
Mailing Address - Country:US
Mailing Address - Phone:067-447-2238
Mailing Address - Fax:806-740-3325
Practice Address - Street 1:10208 QUAKER AVE STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8394
Practice Address - Country:US
Practice Address - Phone:806-795-4500
Practice Address - Fax:806-516-5400
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4930174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113568304Medicaid
TX113568304Medicaid
TXE04586Medicare UPIN