Provider Demographics
NPI:1225006893
Name:MAGNABOSCO, ELIZABETH LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:MAGNABOSCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:LOUISE
Other - Last Name:DYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 N SANTA ROSA ST
Mailing Address - Street 2:F1657
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-4708
Mailing Address - Fax:210-704-2615
Practice Address - Street 1:333 N SANTA ROSA ST
Practice Address - Street 2:F1657
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4708
Practice Address - Fax:210-704-2615
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7723207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117085405Medicaid
TXTXB126834Medicare UPIN