Provider Demographics
NPI:1376566612
Name:PALACIOS, ELIZABETH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 POPPY DR
Mailing Address - Street 2:403
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4621
Mailing Address - Country:US
Mailing Address - Phone:214-328-3186
Mailing Address - Fax:214-328-4085
Practice Address - Street 1:9330 POPPY DR
Practice Address - Street 2:403
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4621
Practice Address - Country:US
Practice Address - Phone:214-328-3186
Practice Address - Fax:214-328-4085
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117317103Medicaid
TX81G572OtherBCBS
TXP0005463OtherRR MEDICARE PIN (D.I.S.)
TX081535901OtherMEDICAID
TX117317101Medicaid
TX110091135OtherRR MEDICARE
TX110091135OtherRR MEDICARE
TX83G903Medicare PIN
TX81G572Medicare PIN