Provider Demographics
NPI:1780845883
Name:ELIZONDO, JOSEPH C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 JEFFERSON ST
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6206
Mailing Address - Country:US
Mailing Address - Phone:512-459-6503
Mailing Address - Fax:512-454-7453
Practice Address - Street 1:6835 AUSTIN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3166
Practice Address - Country:US
Practice Address - Phone:512-346-6611
Practice Address - Fax:512-465-1633
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032358207R00000X
TXN8780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284952302Medicaid
TX284952301Medicaid
TX284952301Medicaid
TXTXB134178Medicare PIN