Provider Demographics
NPI:1295783728
Name:ELIZONDO, EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
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 1:7307 CREEKBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8203
Mailing Address - Country:US
Mailing Address - Phone:512-614-3300
Mailing Address - Fax:512-614-3301
Practice Address - Street 1:7307 CREEKBLUFF DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8203
Practice Address - Country:US
Practice Address - Phone:512-614-3300
Practice Address - Fax:512-614-3301
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5754208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5522360001Medicare NSC
TX8C6107Medicare PIN
TXF63073Medicare UPIN