Individual
DR. ELIZABETH W. FOMBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1402 W AVENUE H, TEMPLE, TX 76504-5342
(254) 771-8411
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L2252
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060065019
RR/MEDICARE
TX
05
—
1457848-01
—
TX
01
—
8B4706
BLUE SHIELD
TX
Enumeration date
03/22/2006
Last updated
08/12/2013
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