=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609337054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REUBEN J. ELOVITZ, M.D., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2019
-----------------------------------------------------
Last Update Date | 03/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6119 BERKSHIRE LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-865-6991
-----------------------------------------------------
Fax | 214-865-6910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6119 BERKSHIRE LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-865-6991
-----------------------------------------------------
Fax | 214-865-6910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | DR. REUBEN J ELOVITZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-501-5395
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------