Provider Demographics
NPI:1144339938
Name:FAZ, ELIUD A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIUD
Middle Name:A
Last Name:FAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELIUD
Other - Middle Name:AURELIO
Other - Last Name:FAZ-GUEVARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4001 MCPHERSON AVE
Mailing Address - Street 2:SUITE. 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5281
Mailing Address - Country:US
Mailing Address - Phone:956-753-6797
Mailing Address - Fax:956-753-6547
Practice Address - Street 1:4001 MCPHERSON AVE
Practice Address - Street 2:SUITE. 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5281
Practice Address - Country:US
Practice Address - Phone:956-753-6797
Practice Address - Fax:956-753-6547
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG09022084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE00248Medicare UPIN
TX8B7417Medicare ID - Type Unspecified