Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2017-01581 | NC |
N | 208600000X | Surgeon | 2017-01581 | NC |
Y | 208200000X | Surgeon | T3059 | TX |
Y | 208600000X | Surgeon | T3059 | TX |
N | 2086S0102X | Surgical Critical Care | T3059 | TX |
NPI | 1063706877 |
---|---|
Provider Name | Elaine M Cleveland |
First Address | El Paso, TX 79905-1613 |
Second Address | El Paso, TX 79905-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 25/01/2022 |