Provider Demographics
NPI:1568548758
Name:HAGEE, ELIZABETH BROOKS (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BROOKS
Last Name:HAGEE
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 1:8606 VILLAGE DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5416
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:210-590-7288
Practice Address - Street 1:8606 VILLAGE DRIVE
Practice Address - Street 2:STE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5416
Practice Address - Country:US
Practice Address - Phone:210-657-0220
Practice Address - Fax:210-590-7288
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1658627-07Medicaid
TX8C0912Medicare ID - Type Unspecified
TX1658627-07Medicaid