Provider Demographics
NPI:1275571283
Name:LOUDON, ELIZABETH (MD PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LOUDON
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 1:7434 LOUIS PASTEUR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4538
Mailing Address - Country:US
Mailing Address - Phone:210-615-9494
Mailing Address - Fax:210-615-1514
Practice Address - Street 1:7434 LOUIS PASTEUR
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4538
Practice Address - Country:US
Practice Address - Phone:210-615-9494
Practice Address - Fax:210-615-1514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6161207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG25890Medicare UPIN
TX0020BNMedicare ID - Type Unspecified