Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | H9509 | TX |
NPI | 1205806171 |
---|---|
Provider Name | Dr. Douglas Elenz |
First Address | Austin, TX 78705-1130 |
Second Address | Austin, TX 78705-1130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117555603 | (05) | TX |
1278600001 | MEDICARE SUPPLIER NUMBER (01) | TX |
G01836 | (02) | TX |