Organization
ELIA FANOUS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIA FANOUS M D (OWNER)
(972) 786-0140
Entity
Organization
Contact information
Practice address
3501 N MACARTHUR BLVD, STE 500, IRVING, TX 75062-3636
(972) 786-0140
Mailing address
3501 N MACARTHUR BLVD, STE 500, IRVING, TX 75062-3636
(972) 786-0140
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M1088
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0026QU
BLUE CROSS BLUE SHIELD
TX
05
—
189357001
—
TX
Enumeration date
11/13/2007
Last updated
10/07/2008
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