Healthcare Provider Details

I. General information

NPI: 1437352614
Provider Name (Legal Business Name): AMARYLLIS MARIA ELPIDA ARRAUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMARYLLIS MARIA ELPIDA HAYS M.D.

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE STE 600
FORT WORTH TX
76104-2158
US

IV. Provider business mailing address

1325 PENNSYLVANIA AVE STE 600
FORT WORTH TX
76104-2158
US

V. Phone/Fax

Practice location:
  • Phone: 817-878-5298
  • Fax: 817-878-5289
Mailing address:
  • Phone: 817-878-5298
  • Fax: 817-878-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberM5219
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberM5219
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD29445
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD29445
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD29445
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: