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Contact Information

OMAR F GHANDOUR, MD
7601 SOUTHCREST PKWY
SOUTHAVEN, MS38671-4739
 Phone: 662-772-2130
 Fax: 662-772-2131
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
Indicates primary specialty

NPI Profile & details for OMAR F GHANDOUR · (Male)

NPI Number 1255323663
Status Active
Credentials MD
Entity Individual
Enumeration date 08/22/2005
Last updated 03/30/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 22217
  • TN License # 36779
  • AR Medicaid 148872001
  • MS Medicaid 00127062
  • TN Medicaid 3876529
  • Other 7160133 AETNA
  • AR Other 99465 BLUE CROSS BLUE SHIELD
  • TN Other 4046696 BLUE CROSS BLUE SHIELD
Hospital affiliation(s)
  • BAPTIST MEMORIAL HOSPITAL - (Acute Care)
    6019 WALNUT GROVE ROAD
    MEMPHIS, TN 38120
  • BAPTIST MEMORIAL HOSPITAL DESOTO - (Acute Care)
    7601 SOUTHCREST PARKWAY
    SOUTHAVEN, MS 38671
  • BAPTIST MEMORIAL HOSPITAL TIPTON - (Acute Care)
    1995 HIGHWAY 51 S
    COVINGTON, TN 38019
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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