Healthcare Provider Details

I. General information

NPI: 1588050033
Provider Name (Legal Business Name): GHAZWAN ELIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E THOMAS RD STE 101
PHOENIX AZ
85016-7766
US

IV. Provider business mailing address

PO BOX 4417
HOUSTON TX
77210-4417
US

V. Phone/Fax

Practice location:
  • Phone: 480-470-0003
  • Fax: 480-470-0004
Mailing address:
  • Phone: 480-470-0003
  • Fax: 480-470-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number66208
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS1392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: