Provider Demographics
NPI:1871737205
Name:GHAYAS, ARJUMAND (MD)
Entity type:Individual
Prefix:
First Name:ARJUMAND
Middle Name:
Last Name:GHAYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARJUMAND
Other - Middle Name:
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E OVERTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5946
Practice Address - Country:US
Practice Address - Phone:214-266-4200
Practice Address - Fax:214-266-4298
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219015902Medicaid
TX8CN580OtherBCBS
TX219015901Medicaid
TX219015903Medicaid
TXTXB117918Medicare PIN