Individual
ELIZABETH TATE DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
313 E 12TH ST STE 102, AUSTIN, TX 78701-1955
(409) 772-2222
Mailing address
1601 RIO GRANDE ST, 340, AUSTIN, TX 78701-1137
(512) 324-7000
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
J1975
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129870506
—
TX
05
—
129870508
—
TX
01
—
86317J
BCBS
TX
Enumeration date
12/14/2006
Last updated
12/14/2012
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