Provider Demographics
NPI:1225219884
Name:EL AZOURY, PAUL GERGI (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GERGI
Last Name:EL AZOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 TOM MILLER ROAD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-314-3610
Mailing Address - Fax:518-562-7542
Practice Address - Street 1:75 BEEKMAN STREET
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-314-3610
Practice Address - Fax:518-562-7542
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013886207RN0300X
NY003631208M00000X
NY271599207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03277603Medicaid
J400025608Medicare UPIN