Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | J1116 | TX |
NPI | 1558483131 |
---|---|
Provider Name | Dr. Elizabeth Ann Teague |
First Address | Plano, TX 75025 |
Second Address | Plano, TX 75025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 09/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F36664 | (02) | TX |
J1116 | TX LICENSE (01) | TX |