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General NPI Number Information
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NPI Number | 1073675401
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Entity Type | Individual
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Provider Name | ELIZABETH TATE DOUGLASS MD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 313 E 12TH ST STE 102
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City | AUSTIN
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State | TX
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Zip | 78701-1955
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Country | US
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Telephone | 409-772-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 RIO GRANDE ST 340
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City | AUSTIN
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State | TX
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Zip | 78701-1137
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Country | US
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Telephone | 512-324-7000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | J1975
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License Number State | TX
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