Healthcare Provider Details

I. General information

NPI: 1861840944
Provider Name (Legal Business Name): ELIZABETH ANNE KUBOTA-MISHRA D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 08/29/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL OFFICE BUILDING, 5TH FLOOR 17580 INTERSTATE 45 SOUTH, WM 560
THE WOODLANDS TX
77384
US

IV. Provider business mailing address

6431 FANNIN ST MSB 3.151
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 936-267-7500
  • Fax:
Mailing address:
  • Phone: 713-500-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8927
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberR8927
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: