Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 45528 | TX |
NPI | 1053763433 |
---|---|
Provider Name | Ghassan M Baslaim |
First Address | Fort Worth, TX 76199-0371 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 08/07/2016 |