Provider Demographics
NPI:1568461309
Name:FALOLA, ELIZABETH O (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:O
Last Name:FALOLA
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7920 ELMBROOK DR STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4933
Practice Address - Country:US
Practice Address - Phone:214-590-2800
Practice Address - Fax:214-590-0865
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124317207Medicaid
TX124317209Medicaid
TX124317211Medicaid
TX124317220Medicaid
TN124317214Medicaid
TN124317217Medicaid
TX124317221Medicaid
TX124317213Medicaid
TX124317218Medicaid
TX124317202Medicaid
TX124317210Medicaid
TX124317215Medicaid
TX8757J1Medicare PIN
TX124317210Medicaid