Provider Demographics
NPI:1679598981
Name:ELIZONDO, ROY J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:J
Last Name:ELIZONDO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:MISS
Other - First Name:DELMA
Other - Middle Name:RUTH
Other - Last Name:ARSIAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:8257 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3357
Mailing Address - Country:US
Mailing Address - Phone:210-616-0715
Mailing Address - Fax:
Practice Address - Street 1:8257 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3357
Practice Address - Country:US
Practice Address - Phone:210-616-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099441001Medicaid
TXB22507Medicare UPIN
TX099441001Medicaid