Provider Demographics
NPI:1659365203
Name:PODOBA, ELIZABETH C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:PODOBA
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 1:11302 FALLBROOK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4235
Mailing Address - Country:US
Mailing Address - Phone:281-894-2900
Mailing Address - Fax:281-890-4196
Practice Address - Street 1:11302 FALLBROOK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4235
Practice Address - Country:US
Practice Address - Phone:281-894-2900
Practice Address - Fax:281-890-4196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25561Medicare UPIN