Healthcare Provider Details

I. General information

NPI: 1801424098
Provider Name (Legal Business Name): ELIZABETH AZIZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MEDICAL CARE DR
BRANDON FL
33511-5942
US

IV. Provider business mailing address

4197 WOODLANDS PKWY
PALM HARBOR FL
34685-3493
US

V. Phone/Fax

Practice location:
  • Phone: 813-657-3330
  • Fax: 813-657-3348
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS21382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: