| Elias I Fanous Jr Md Pa | |
|
700 Olympic Plaza Cir Suite 508 Tyler TX 75701-1951 | |
| (903) 526-3030 | |
| Not Available |
| Full Name | Elias I Fanous Jr Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 700 Olympic Plaza Cir, Tyler, Texas |
| Authorized Official Name and Position | Elias I Fanous (OWNER) |
| Authorized Official Contact | 9035263030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elias I Fanous Jr Md Pa 700 Olympic Plaza Cir Suite 508 Tyler TX 75701-1951 Ph: (903) 526-3030 | Elias I Fanous Jr Md Pa 700 Olympic Plaza Cir Suite 508 Tyler TX 75701-1951 Ph: (903) 526-3030 |
| NPI Number | 1982880647 |
|---|---|
| Provider Enumeration Date | 01/11/2008 |
| Last Update Date | 01/14/2008 |
| Medicare PECOS PAC ID | 6507844685 |
|---|---|
| Medicare Enrollment ID | O20040713001607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982880647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | H8030 (Texas) | Primary |
| Provider Name | Elias I Fanous |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1760478689 PECOS PAC ID: 9133107212 Enrollment ID: I20101108001447 |
| Provider Name | Aric Barrios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407300817 PECOS PAC ID: 8628366622 Enrollment ID: I20161006001375 |
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