Healthcare Provider Details

I. General information

NPI: 1144664749
Provider Name (Legal Business Name): ELISABETH PORTER GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISABETH PORTER BROWN

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 HARRY HINES BLVD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax: 214-645-9225
Mailing address:
  • Phone: 214-645-8300
  • Fax: 214-645-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR4047
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: