Provider Demographics
NPI:1629161500
Name:KING, ELIZABETH E (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:KING
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8857
Mailing Address - Country:US
Mailing Address - Phone:214-648-3494
Mailing Address - Fax:214-648-8917
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8857
Practice Address - Country:US
Practice Address - Phone:214-648-3494
Practice Address - Fax:214-648-8917
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4247207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183667801Medicaid
TX8J1770Medicare PIN