Provider Demographics
NPI:1417391764
Name:ELIZONDO, CARLOS RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-0850
Mailing Address - Country:US
Mailing Address - Phone:361-902-6570
Mailing Address - Fax:361-881-1467
Practice Address - Street 1:230 S GULF ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4310
Practice Address - Country:US
Practice Address - Phone:361-664-0303
Practice Address - Fax:866-845-0933
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ6183207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine