Provider Demographics
NPI:1710099130
Name:KRISHNAN, ELIZABETH GOPAL (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GOPAL
Last Name:KRISHNAN
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 1:1331 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6601
Mailing Address - Country:US
Mailing Address - Phone:956-968-9502
Mailing Address - Fax:956-968-7269
Practice Address - Street 1:1331 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6601
Practice Address - Country:US
Practice Address - Phone:956-968-9502
Practice Address - Fax:956-968-7269
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1357207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P422Medicare ID - Type Unspecified
TXD66766Medicare UPIN