Healthcare Provider Details

I. General information

NPI: 1467776252
Provider Name (Legal Business Name): WALAA ELFAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N WILMOT RD STE 101
TUCSON AZ
85711-2683
US

IV. Provider business mailing address

BANNER- UNIVERSITY MEDICAL GROUP PO BOX 74136
LOS ANGELES CA
90074-1736
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-5437
  • Fax: 520-874-7070
Mailing address:
  • Phone: 520-694-5437
  • Fax: 520-874-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number67516
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: