Healthcare Provider Details

I. General information

NPI: 1891228847
Provider Name (Legal Business Name): ELIZABETH OKONEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MROZEK

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-4854
  • Fax:
Mailing address:
  • Phone: 757-953-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberU1983
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU1983
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: