Provider Demographics
NPI:1891773933
Name:JEKOT, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JEKOT
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:PO BOX 832265
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-2265
Mailing Address - Country:US
Mailing Address - Phone:469-814-5500
Mailing Address - Fax:
Practice Address - Street 1:3301 E RENNER RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2801
Practice Address - Country:US
Practice Address - Phone:469-814-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH81552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080064149OtherRAILROAD
TX00R68ROtherBCBS
TX132322207Medicaid
TX82X790OtherBCBS
TX084868101Medicaid
TX132322204Medicaid
TX080064149OtherMEDICARE RAILROAD
TX82X790OtherBCBS
TX8F1349Medicare ID - Type Unspecified
TX132322204Medicaid