Individual
MARY ZELIME ELIBOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1300 W LANCASTER AVE STE 205, FORT WORTH, TX 76102-3490
(817) 336-8611
(817) 390-2981
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1860
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
L-232250
MA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
15949
NH
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
252548
MA
Other
Enumeration date
06/15/2007
Last updated
04/06/2021
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