Provider Demographics
NPI:1477733996
Name:CHABOKROW, LIZA (DPM)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:CHABOKROW
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91674
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-1674
Mailing Address - Country:US
Mailing Address - Phone:512-394-5108
Mailing Address - Fax:512-394-5109
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE K1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8600
Practice Address - Country:US
Practice Address - Phone:512-394-5108
Practice Address - Fax:512-394-5109
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1901213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5634OtherGROUP PTAN
TX2129181Medicaid
TX2129157Medicaid
TXDQ3405OtherMEDICARE RAILROAD
TXP00838858OtherMEDICARE RAILROAD
TXP00838858OtherMEDICARE RAILROAD
TX2129181Medicaid
TX264926YMSWMedicare PIN
TX8F23560Medicare UPIN