Provider Demographics
NPI:1588823363
Name:BAH, ELIZABETH LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:BAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7029
Mailing Address - Country:US
Mailing Address - Phone:817-753-6888
Mailing Address - Fax:
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7029
Practice Address - Country:US
Practice Address - Phone:817-753-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289501301Medicaid
TXP01068153Medicare PIN
TX289501301Medicaid