Provider Demographics
NPI:1386000800
Name:ELISABETH POTTER MD PLLC
Entity Type:Organization
Organization Name:ELISABETH POTTER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:HOUSE
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-794-7714
Mailing Address - Street 1:1101 W 34TH ST
Mailing Address - Street 2:#321
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1907
Mailing Address - Country:US
Mailing Address - Phone:512-867-6211
Mailing Address - Fax:512-867-6216
Practice Address - Street 1:6818 AUSTIN CENTER BLVD
Practice Address - Street 2:STE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3158
Practice Address - Country:US
Practice Address - Phone:512-867-6211
Practice Address - Fax:512-867-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty