Provider Demographics
NPI:1417201948
Name:DEVLIN, ELIZABETH BUZA (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BUZA
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 57
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:TX
Mailing Address - Zip Code:77413
Mailing Address - Country:US
Mailing Address - Phone:281-599-8345
Mailing Address - Fax:281-599-3030
Practice Address - Street 1:21312 PROVINCIAL BLVD.
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-599-8345
Practice Address - Fax:281-599-3030
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical