Healthcare Provider Details

I. General information

NPI: 1467357772
Provider Name (Legal Business Name): AMR ANTAR ELFAYOUME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-1000
  • Fax: 602-933-1000
Mailing address:
  • Phone: 602-933-4012
  • Fax: 602-933-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberR82447
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: