Organization
ELIAS I FANOUS JR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIAS I FANOUS JR. (OWNER)
(903) 526-3030
Entity
Organization
Contact information
Practice address
700 OLYMPIC PLAZA CIR, SUITE 508, TYLER, TX 75701-1951
(903) 526-3030
Mailing address
700 OLYMPIC PLAZA CIR, SUITE 508, TYLER, TX 75701-1951
(903) 526-3030
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
H8030
TX
Other
Enumeration date
01/11/2008
Last updated
01/14/2008
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