Provider Demographics
NPI:1568496172
Name:LU, ELIZABETH T (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:T
Last Name:LU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 US HIGHWAY 51 BYP E
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2079
Mailing Address - Country:US
Mailing Address - Phone:731-287-3130
Mailing Address - Fax:731-287-3818
Practice Address - Street 1:600 US HIGHWAY 51 BYP E
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2079
Practice Address - Country:US
Practice Address - Phone:731-287-3130
Practice Address - Fax:731-287-3818
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000658213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6409830002OtherMEDICARE NSC PTAN#
TN6409830001OtherMEDICARE NSC PTAN #