Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 4998 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 11531R | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 15501 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | 4998 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | J8547 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD11531R | LA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 11531R | LA |
NPI | 1417981739 |
---|---|
Provider Name | Dr. Ghali Elias Ghali |
First Address | Shreveport, LA 71118 |
Second Address | Shreveport, LA 71118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1899496 | (05) | LA |