MEDICARE: DR. ELIZABETH TICE DPM

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	213E00000X	Podiatrist	80188	MS

General Provider Information

NPI Number	:	1578665394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH TICE DPM

Provider Business Mailing Address
First Line	:	1860 CHADWICK DR STE 206
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39204-3466
Country	:	US
Telephone Number	:	601-376-2963
Fax Number	:	601-376-2967

Provider Business Practice Location Address
First Line	:	1860 CHADWICK DR
Second Line	:	SUITE 106
City	:	JACKSON
State	:	MS
Zip	:	39204-3463
Country	:	US
Telephone Number	:	601-376-2963
Fax Number	:	601-376-2967

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	02/26/2018

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Directions to “ DR. ELIZABETH TICE DPM” Practice Location

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