Healthcare Provider Details

I. General information

NPI: 1346316072
Provider Name (Legal Business Name): ELIZABETH CALLEJO TOLOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W FAULKNER
EL DORADO AR
71730
US

IV. Provider business mailing address

PO BOX 1815
EL DORADO AR
71730
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-2433
  • Fax: 870-862-2776
Mailing address:
  • Phone: 870-862-2433
  • Fax: 870-862-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE0066
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: