Provider Demographics
NPI:1457336612
Name:COLONNA, ELIZABETH ALICE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALICE
Last Name:COLONNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:EYRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1830 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2020
Mailing Address - Country:US
Mailing Address - Phone:210-670-9030
Mailing Address - Fax:210-675-4072
Practice Address - Street 1:1830 EDGEHILL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-670-9030
Practice Address - Fax:210-675-4072
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0986207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098326401Medicaid
TXP000F89D4Medicaid
TXC14676Medicare UPIN
TXP000F89D4Medicaid