Healthcare Provider Details

I. General information

NPI: 1801955612
Provider Name (Legal Business Name): ELSA N BELLO REUSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST STOP 9410
LUBBOCK TX
79430-9410
US

IV. Provider business mailing address

3601 4TH ST STOP 9410
LUBBOCK TX
79430-9410
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3155
  • Fax:
Mailing address:
  • Phone: 806-743-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH5525
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: