Provider Demographics
NPI:1003043662
Name:SOLIZ, EBEN O (PA)
Entity Type:Individual
Prefix:
First Name:EBEN
Middle Name:O
Last Name:SOLIZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:720 W 34TH ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1211
Practice Address - Country:US
Practice Address - Phone:512-454-5821
Practice Address - Fax:512-459-9137
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2023-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6B1720OtherMEDICARE PTAN