Provider Demographics
NPI:1255325429
Name:BURNELL, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BURNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 DENALI PASS STE 604
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7766
Mailing Address - Country:US
Mailing Address - Phone:512-259-2222
Mailing Address - Fax:512-259-2290
Practice Address - Street 1:507 DENALI PASS STE 604
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7766
Practice Address - Country:US
Practice Address - Phone:512-906-0168
Practice Address - Fax:512-259-2290
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA082123207Q00000X
TN58564207Q00000X
TXK2315207Q00000X
OH35.135509207Q00000X
DEC1-0013036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200928401Medicaid
TX200928401Medicaid
TXG70715Medicare UPIN
TXG70715Medicare UPIN
TXTXB116884Medicare PIN