Provider Demographics
NPI:1417133711
Name:MEYER, ELIZABETH BLAIR MANNING (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BLAIR MANNING
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3412 OVERTON PARK DR W
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2504
Mailing Address - Country:US
Mailing Address - Phone:210-896-7751
Mailing Address - Fax:
Practice Address - Street 1:3412 OVERTON PARK DR W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2504
Practice Address - Country:US
Practice Address - Phone:210-896-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4205208100000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine