Provider Demographics
NPI:1497776991
Name:WINFUL-ACQUAYE, ELIZABETH C N (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C N
Last Name:WINFUL-ACQUAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:AUSTIN REGIONAL CLINIC
Practice Address - Street 2:12779 WEST SH 29
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6332
Practice Address - Country:US
Practice Address - Phone:512-778-7003
Practice Address - Fax:512-406-7317
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107763801Medicaid
TX453849Medicare ID - Type Unspecified
TX107763801Medicaid