MEDICARE: MRS. ELIZABETH EVERSULL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	L5328	TX
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	L5328	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154380517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH EVERSULL MD

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:
City	:	BOYCE
State	:	LA
Zip	:	71409-0097
Country	:	US
Telephone Number	:	972-309-2021
Fax Number	:	972-309-2023

Provider Business Practice Location Address
First Line	:	5944 W PARKER RD
Second Line	:	#400
City	:	PLANO
State	:	TX
Zip	:	75093-6421
Country	:	US
Telephone Number	:	972-309-2021
Fax Number	:	972-309-2023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	10/23/2008

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