Provider Demographics
NPI:1518258433
Name:JILES, ELISICIA LOUISE TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:ELISICIA
Middle Name:LOUISE TAYLOR
Last Name:JILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISICIA
Other - Middle Name:LOUISE TAYLOR
Other - Last Name:VOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1801 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8001
Mailing Address - Country:US
Mailing Address - Phone:830-768-9200
Mailing Address - Fax:830-774-3534
Practice Address - Street 1:1878 JEFF RD NW STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4261
Practice Address - Country:US
Practice Address - Phone:256-562-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.32720207Q00000X
ALL3480R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine