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NPI Code Detail

MEDICARE: ELISABETH NETHERTON MD LLC

MEDICARE: ELISABETH NETHERTON MD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianQ3066TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11851835955OTHERTXNPI

General Provider Information

NPI Number : 1124530936
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELISABETH NETHERTON MD LLC
Provider Business Mailing Address
First Line : 2901 WILCREST DR STE 520
Second Line :
City : HOUSTON
State : TX
Zip : 77042-6073
Country : US
Telephone Number : 713-400-7400
Fax Number :
Provider Business Practice Location Address
First Line : 2901 WILCREST DR STE 520
Second Line :
City : HOUSTON
State : TX
Zip : 77042-6073
Country : US
Telephone Number : 713-400-7400
Fax Number :
Authorized Official
Title or Position : PSYCHIATRIST
Name : DR. ELISABETH NETHERTON
Credential : MD
Telephone Number : 832-390-1878
Provider Enumeration Date : 11/02/2017
Last Update Date : 11/02/2017

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Directions to “ELISABETH NETHERTON MD LLC ” Practice Location

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