Provider Demographics
NPI:1770548786
Name:AZZI, ELI (MD)
Entity type:Individual
Prefix:DR
First Name:ELI
Middle Name:
Last Name:AZZI
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-606-1914
Practice Address - Fax:903-606-1930
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8513207R00000X, 207RC0200X
LA308048207RC0200X, 207RP1001X
IN01056003A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770548786OtherBLUE CROSS BLUE SHIELD
TX197645801Medicaid
TXP01092504OtherRR MEDICARE
TX197645802Medicaid
TXP01254126OtherMEDICARE RR
TXP01092504OtherRR MEDICARE
TX197645801Medicaid
TX319440YMVQMedicare PIN
TX197645802Medicaid