Provider Demographics
NPI:1407181654
Name:DALLMAYR, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:DALLMAYR
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:C37 CALLE LOS ROBLES
Mailing Address - Street 2:MANSIONES DE ROMANY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5415
Mailing Address - Country:US
Mailing Address - Phone:787-646-0369
Mailing Address - Fax:
Practice Address - Street 1:C37 CALLE LOS ROBLES
Practice Address - Street 2:MANSIONES DE ROMANY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5415
Practice Address - Country:US
Practice Address - Phone:787-646-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17694390200000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program