Provider Demographics
NPI:1497011738
Name:JENKINS, ELIZABETH PREZIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PREZIO
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:PREZIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:101 COLORADO ST
Mailing Address - Street 2:#1108
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4103
Mailing Address - Country:US
Mailing Address - Phone:214-801-9843
Mailing Address - Fax:512-428-5786
Practice Address - Street 1:101 COLORADO ST
Practice Address - Street 2:#1108
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4103
Practice Address - Country:US
Practice Address - Phone:214-801-9843
Practice Address - Fax:512-428-5786
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5180207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH5180OtherTEXAS MEDICAL BOARD
TXH0114221OtherTEXAS DEPARTMENT OF PUBLIC SAFETY