Provider Demographics
NPI:1831109909
Name:ELIZONDO, BEN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:JOSEPH
Last Name:ELIZONDO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5000
Mailing Address - Fax:602-470-5064
Practice Address - Street 1:3201 UNIVERSITY DR E STE 255
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3483
Practice Address - Country:US
Practice Address - Phone:979-330-7140
Practice Address - Fax:979-256-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49076208000000X, 2080P0206X
TXJ77762080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG23827Medicare UPIN
00203GMedicare ID - Type Unspecified