Provider Demographics
NPI:1346316072
Name:TOLOSA, ELIZABETH CALLEJO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CALLEJO
Last Name:TOLOSA
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:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-2433
Mailing Address - Fax:870-862-2776
Practice Address - Street 1:706 W FAULKNER
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-862-2433
Practice Address - Fax:870-862-2776
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J325OtherBLUE CROSS BLUE SHIELD
AR5J325OtherBLUE CROSS BLUE SHIELD