Provider Demographics
NPI:1164513271
Name:ELIZABETH A JOHN MD PA
Entity Type:Organization
Organization Name:ELIZABETH A JOHN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-782-6116
Mailing Address - Street 1:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539
Mailing Address - Country:US
Mailing Address - Phone:813-782-6116
Mailing Address - Fax:813-780-1051
Practice Address - Street 1:6340 FORT KING ROAD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542
Practice Address - Country:US
Practice Address - Phone:813-782-6116
Practice Address - Fax:813-780-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
49952OtherBCBS
K8104Medicare ID - Type Unspecified
49952OtherBCBS