Provider Demographics
NPI:1689667339
Name:BABCOCK, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 SW 75TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5779
Mailing Address - Country:US
Mailing Address - Phone:352-332-2990
Mailing Address - Fax:352-332-7503
Practice Address - Street 1:100 SW 75TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5779
Practice Address - Country:US
Practice Address - Phone:352-332-2990
Practice Address - Fax:352-332-7503
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251657800Medicaid
FL251657800Medicaid
FLG46827Medicare UPIN