Provider Demographics
NPI:1588050033
Name:ELIAS, GHAZWAN (MD)
Entity type:Individual
Prefix:
First Name:GHAZWAN
Middle Name:
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4417
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4417
Mailing Address - Country:US
Mailing Address - Phone:480-470-0003
Mailing Address - Fax:480-470-0004
Practice Address - Street 1:1910 E THOMAS RD STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7766
Practice Address - Country:US
Practice Address - Phone:480-470-0003
Practice Address - Fax:480-470-0004
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1392208M00000X
AZ66208207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX404555101Medicaid
AZ149289Medicaid