Alaa Bou Ghannam, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

TL.0005920 Issued in CO

Practice address

13001 E 17TH PL
Aurora, CO 80045-2570

Phone

(303) 724-5000

NPI assigned

Jul 23, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1508241209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 LAWRENCE ST APT 606",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052896",
            "telephone_number": "202-531-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13001 E 17TH PL",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452570",
            "telephone_number": "303-724-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOU GHANNAM",
        "first_name": "ALAA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-23",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "DC",
            "license": "MTL002799",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0116028520",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CO",
            "license": "TL.0005920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoebe Botsford, LPCC
• David M Bott, RPH
• Yasmine Botto, PHD
• Catherine L Bottoms
• Chad Botz, MD
• Lauren Therese Josiah Bouchard, MD
• Adria Boucharel, MD
• Todd Michael Boucher, PA-C
• Bonnie Jeanne Boudakian, R.N., B.S.N.
• Brent F Boudreaux

• Ophthalmology Physician in Aurora, CO
• Providers in Aurora, CO by specialty
• Ophthalmology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.