Provider Demographics
NPI:1982996435
Name:JALAZO, ELIZABETH ROUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROUTH
Last Name:JALAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WINSTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9194
Mailing Address - Country:US
Mailing Address - Phone:919-923-6583
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE CB #7487
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-9194
Practice Address - Country:US
Practice Address - Phone:919-966-4202
Practice Address - Fax:919-966-3025
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty