Provider Demographics
NPI:1164623351
Name:ODSTRCIL, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:ODSTRCIL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:3417 GASTON AVENUE
Practice Address - Street 2:SUITE 790
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-821-5266
Practice Address - Fax:214-821-0459
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN1028207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210543901Medicaid
TX8CA798OtherBCBSTX
TX8CA798OtherBCBSTX
8L19395Medicare PIN