Active NPI
Epifanio Elizondo, PA-C
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1073784245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01753
- Practice address
- 1711 Doolittle Ave
Nas JRB Branch Clinic
Fort Worth, TX 76127-1133 - Phone
- (817) 782-5923
- Fax
- (817) 782-5949
- NPI assigned
- Mar 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01753 | TX | Primary |
Addresses
Primary practice location
1711 Doolittle Ave
Nas JRB Branch Clinic
Fort Worth, TX 76127-1133
Mailing address
204 Meadow Creek LN
Burleson, TX 76028-7960
Phone (817) 447-7788
Other names 1
- Epi Elizondo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01753 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205712000000",
"number": "1073784245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 MEADOW CREEK LN",
"city": "BURLESON",
"state": "TX",
"postal_code": "760287960",
"telephone_number": "817-447-7788",
"fax_number": "214-767-3209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1711 DOOLITTLE AVE",
"address_2": "NAS JRB BRANCH CLINIC",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761271133",
"telephone_number": "817-782-5923",
"fax_number": "817-782-5949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELIZONDO",
"first_name": "EPIFANIO",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-17",
"last_updated": "2008-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA01753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EPI",
"last_name": "ELIZONDO",
"credential": "PA-C",
"code": "5",
"type": "Other Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.