Provider Demographics
NPI:1558405209
Name:CARSON, ELIZABETH A (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:CARSON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:16515 S 40TH ST
Mailing Address - Street 2:SUITE 139
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0558
Mailing Address - Country:US
Mailing Address - Phone:480-706-0174
Mailing Address - Fax:480-706-0117
Practice Address - Street 1:16515 S 40TH ST
Practice Address - Street 2:SUITE 139
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0558
Practice Address - Country:US
Practice Address - Phone:480-706-0174
Practice Address - Fax:480-706-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH53159Medicare UPIN