Provider Demographics
NPI:1659376622
Name:EL-BAYAR, HISHAM (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:HISHAM
Middle Name:
Last Name:EL-BAYAR
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W. LAVETA AVE
Mailing Address - Street 2:STE. 470
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-835-8300
Mailing Address - Fax:714-835-8304
Practice Address - Street 1:1010 W. LAVETA AVE
Practice Address - Street 2:STE. 470
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4305
Practice Address - Country:US
Practice Address - Phone:714-835-8300
Practice Address - Fax:714-835-8304
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A452991Medicaid
CA00A452991OtherBLUE CROSS/BLUE SHIELD
CA00A452991OtherBLUE CROSS/BLUE SHIELD
CAA45299AMedicare ID - Type Unspecified