Provider Demographics
NPI:1477749422
Name:ELIZABETH BABCOCK, MD, PA
Entity Type:Organization
Organization Name:ELIZABETH BABCOCK, MD, PA
Other - Org Name:WESTEND MEDICAL AND AESTHIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-332-2990
Mailing Address - Street 1:100 SW 75TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5779
Mailing Address - Country:US
Mailing Address - Phone:352-332-2990
Mailing Address - Fax:352-332-7503
Practice Address - Street 1:100 SW 75TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5779
Practice Address - Country:US
Practice Address - Phone:352-332-2990
Practice Address - Fax:352-332-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72504173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG46827Medicare UPIN