Provider Demographics
NPI:1255312724
Name:BARRON, ELAINE MOWINSKI (MD PA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MOWINSKI
Last Name:BARRON
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13037
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-3037
Mailing Address - Country:US
Mailing Address - Phone:915-533-3566
Mailing Address - Fax:915-533-6102
Practice Address - Street 1:3030 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-1014
Practice Address - Country:US
Practice Address - Phone:915-533-3566
Practice Address - Fax:915-533-6102
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000W7116Medicaid
TX114134301Medicaid
TX110152622Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
NM000W7116Medicaid
E03372Medicare UPIN