Healthcare Provider Details

I. General information

NPI: 1205806171
Provider Name (Legal Business Name): DOUGLAS ELENZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 38TH ST SUITE 300
AUSTIN TX
78705-1130
US

IV. Provider business mailing address

900 W 38TH ST SUITE 300
AUSTIN TX
78705-1130
US

V. Phone/Fax

Practice location:
  • Phone: 512-450-1300
  • Fax: 512-450-1339
Mailing address:
  • Phone: 512-450-1300
  • Fax: 512-450-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberH9509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: