MEDICARE: DR. LILLIAN BETH ENGELSGJERD M.D.

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	207VG0400X	Gynecology Physician	F1528	TX

General Provider Information

NPI Number	:	1427037191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILLIAN BETH ENGELSGJERD M.D.

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR
Second Line	:	SUITE 275
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3735
Country	:	US
Telephone Number	:	210-616-0676
Fax Number	:	210-616-0059

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR
Second Line	:	SUITE 275
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3735
Country	:	US
Telephone Number	:	210-616-0676
Fax Number	:	210-616-0059

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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