=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073576583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH HUGHES TICHY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2006
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6712 N NEW BRAUNFELS AVE
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78209-3830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5585
-----------------------------------------------------
Fax | 210-617-5594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6712 N NEW BRAUNFELS AVE
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78209-3830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5585
-----------------------------------------------------
Fax | 210-617-5594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | M1381
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------