Individual
DR. ELMER J. LIZAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8059 SCYENE CIR, DALLAS, TX 75227-5534
(800) 257-8715
(800) 819-1655
Mailing address
10226 DEERMONT TRL, DALLAS, TX 75243-2525
(972) 644-6398
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
22747
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116012902
—
TX
05
—
116012903
—
TX
05
—
116012904
—
TX
01
—
680007553
RAIL ROAD
TX
01
—
86075A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/05/2006
Last updated
07/09/2007
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