Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD35262 | AL |
N | 111NI0900X | Internist | MD35262 | AL |
N | 207R00000X | Internist | Q6162 | TX |
N | 111NI0900X | Internist | Q6162 | TX |
Y | 207RH0002X | Hospice and Palliative Medicine | Q6162 | TX |
NPI | 1215297403 |
---|---|
Provider Name | Elizabeth Alexandra Carroll |
First Address | Dallas, TX 75246-1800 |
Second Address | Dallas, TX 75246-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 15/07/2019 |