Provider Demographics
NPI:1811971187
Name:CASPIAN, ELIZABETH J (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:CASPIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIRINGINA
Other - Middle Name:E
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8720 CRYSTAL VIEW
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004
Mailing Address - Country:US
Mailing Address - Phone:928-774-7793
Mailing Address - Fax:928-774-7795
Practice Address - Street 1:2380 N. OAKMONT DRIVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-774-7793
Practice Address - Fax:928-774-7795
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ286862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry