Provider Demographics
NPI:1073625497
Name:GAGE, ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:GAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2124 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2218
Mailing Address - Country:US
Mailing Address - Phone:469-441-6613
Mailing Address - Fax:940-498-0112
Practice Address - Street 1:1035 HICKORY CREEK BLVD
Practice Address - Street 2:
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7552
Practice Address - Country:US
Practice Address - Phone:713-335-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01853363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPAO1853OtherPA PERMIT