Provider Demographics
NPI:1063436319
Name:JOHN, ELIZABETH MANI (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MANI
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2700 TIBBETS DR
Mailing Address - Street 2:#408
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-545-8895
Mailing Address - Fax:817-545-8897
Practice Address - Street 1:2700 TIBBETS DR
Practice Address - Street 2:#408
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-545-8895
Practice Address - Fax:817-545-8897
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG30052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0072CAMedicare ID - Type Unspecified
E80383Medicare UPIN