Healthcare Provider Details

I. General information

NPI: 1831625433
Provider Name (Legal Business Name): DANIEL ELIAS FUGUET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CIVIC SQ STE 120
GOODYEAR AZ
85395-2390
US

IV. Provider business mailing address

13333 NORTHWEST FWY STE 540
HOUSTON TX
77040-6166
US

V. Phone/Fax

Practice location:
  • Phone: 928-813-4624
  • Fax:
Mailing address:
  • Phone: 407-223-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number353010
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number68225
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: