Provider Demographics
NPI:1063771004
Name:PARK, ELIZABETH YAE-NA (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YAE-NA
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WATER ST SW
Mailing Address - Street 2:NPU 6-03
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2471
Mailing Address - Country:US
Mailing Address - Phone:646-236-1006
Mailing Address - Fax:
Practice Address - Street 1:ONE BAYLOR PLAZA
Practice Address - Street 2:BAYLOR COLLEGE OF MEDICINE BCM 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:646-236-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine