Provider Demographics
NPI:1780864595
Name:CLANTON, ELIZABETH B (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:B
Last Name:CLANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:BOHNENBLUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8038 WURZBACH RD STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3812
Mailing Address - Country:US
Mailing Address - Phone:210-460-7632
Mailing Address - Fax:210-591-1192
Practice Address - Street 1:8038 WURZBACH RD STE 280
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3812
Practice Address - Country:US
Practice Address - Phone:210-460-7632
Practice Address - Fax:210-591-1192
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN68192086S0120X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218397201Medicaid
TX218397201Medicaid