Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101271403 | VA |
NPI | 1033671599 |
---|---|
Provider Name | Elizabeth Lee Carpenter |
First Address | San Antonio, TX 78215-1385 |
Second Address | Jbsa Ft Sam Houston, TX 78234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 02/03/2021 |