Provider Demographics
NPI:1669578761
Name:ELIZABETH A JEKOT MD PA
Entity type:Organization
Organization Name:ELIZABETH A JEKOT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEKOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-442-7050
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:972-758-3598
Mailing Address - Fax:972-599-9604
Practice Address - Street 1:3301 E RENNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-1801
Practice Address - Country:US
Practice Address - Phone:972-442-7050
Practice Address - Fax:214-442-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM007932085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R68ROtherBCBS
TX084868101Medicaid
TX00R68RMedicare PIN
TX084868101Medicaid