Healthcare Provider Details

I. General information

NPI: 1417960048
Provider Name (Legal Business Name): ELIZABETH A MCGINNIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A GLYNN PA

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 W PLANO PKWY STE 1000
PLANO TX
75093-1621
US

IV. Provider business mailing address

6957 W PLANO PKWY STE 1000
PLANO TX
75093-1621
US

V. Phone/Fax

Practice location:
  • Phone: 972-939-8294
  • Fax: 214-731-0240
Mailing address:
  • Phone: 972-939-8294
  • Fax: 214-731-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085002291
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06182
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: