Individual
ELIA FANOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3501 N MACARTHUR BLVD, SUITE 500, IRVING, TX 75062-3636
(972) 256-3700
(972) 258-9887
Mailing address
3501 N MACARTHUR BLVD, SUITE 500, IRVING, TX 75062-3636
(972) 256-3700
(972) 258-9887
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M1088
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188387801
—
TX
01
—
8AU310
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/28/2006
Last updated
10/07/2008
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