Healthcare Provider Details

I. General information

NPI: 1346770781
Provider Name (Legal Business Name): AMMAR FADLALLA ELJACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 JOE BATTLE BLVD
EL PASO TX
79936-0962
US

IV. Provider business mailing address

1840 JOE BATTLE BLVD
EL PASO TX
79936-0962
US

V. Phone/Fax

Practice location:
  • Phone: 915-249-4344
  • Fax: 915-307-2765
Mailing address:
  • Phone: 915-249-4344
  • Fax: 915-307-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301112401
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberBP10070346
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number41229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: