Healthcare Provider Details

I. General information

NPI: 1376699751
Provider Name (Legal Business Name): ELIZABETH A JEKOT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E RENNER RD STE. 100
RICHARDSON TX
75082-1801
US

IV. Provider business mailing address

PO BOX 832265
RICHARDSON TX
75083-2265
US

V. Phone/Fax

Practice location:
  • Phone: 214-442-7050
  • Fax: 214-442-7075
Mailing address:
  • Phone: 214-442-7050
  • Fax: 214-442-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH8155
License Number StateTX

VIII. Authorized Official

Name: DR. ELIZABETH A JEKOT
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: MD
Phone: 214-442-7050