Elia Fanous MD PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

M1088 Issued in TX

Legal business name

ELIA FANOUS MD PA

Practice address

3501 N Macarthur Blvd
Ste 500
Irving, TX 75062-3636

Phone

(972) 786-0140

NPI assigned

Nov 13, 2007

Organization subpart

No

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

Authorized official

Name

Elia Fanous, M D

Title

Owner

Phone

(972) 786-0140

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1043490527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 N MACARTHUR BLVD",
            "address_2": "STE 500",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623636",
            "telephone_number": "972-786-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 N MACARTHUR BLVD",
            "address_2": "STE 500",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623636",
            "telephone_number": "972-786-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIA FANOUS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "FANOUS",
        "authorized_official_first_name": "ELIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-786-0140",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "M1088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189357001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0026QU",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.