Provider Demographics
NPI:1538264684
Name:FAYBUSH, ELISA M (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:M
Last Name:FAYBUSH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5095
Mailing Address - Country:US
Mailing Address - Phone:480-545-6060
Mailing Address - Fax:480-632-0467
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7286
Practice Address - Country:US
Practice Address - Phone:480-545-6060
Practice Address - Fax:480-632-0467
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2017-02-16
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Provider Licenses
StateLicense IDTaxonomies
AZ33833207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ33833OtherSTATE LICENSE NUMBER