Organization
TERESA M. ELLIOTT,MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA MARIE ELLIOTT MD (PRESIDENT)
(214) 361-5070
Entity
Organization
Contact information
Practice address
12801 MIDWAY RD, SUITE 217, DALLAS, TX 75244-6813
(214) 361-5070
(972) 241-5075
Mailing address
12801 MIDWAY RD, SUITE 217, DALLAS, TX 75244-6813
(214) 361-5070
(972) 241-5075
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
F5194
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013Z
MEDICARE GROUP #
TX
Enumeration date
11/25/2008
Last updated
02/23/2012
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