Provider Demographics
NPI:1457309981
Name:DAUGHTRY, ELIZABETH BASS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BASS
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:103 PARKWAY OFFICE CT.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:910-892-3338
Mailing Address - Fax:910-892-2706
Practice Address - Street 1:700 TILGHMAN DR
Practice Address - Street 2:SUITE 722
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-0007
Practice Address - Country:US
Practice Address - Phone:910-892-3338
Practice Address - Fax:910-892-2706
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC489213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903964Medicaid
NC081CCOtherBCBS
NC1207270001Medicare NSC
NC081CCOtherBCBS
NCP00630611Medicare PIN
NCV10387Medicare UPIN
NC2430193CMedicare PIN