Provider Demographics
NPI:1598741944
Name:ELWAZIR, ESMAIL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ESMAIL
Middle Name:M
Last Name:ELWAZIR
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 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2153
Practice Address - Street 1:3417 GASTON AVE STE 800
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2034
Practice Address - Country:US
Practice Address - Phone:214-323-8500
Practice Address - Fax:214-820-7463
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3721207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8303J0OtherBCBS
TX041791701Medicaid
TX8303J0OtherBCBS
TX100012924Medicare PIN
TX8303J0Medicare PIN
TX8303J0Medicare ID - Type Unspecified