Provider Demographics
NPI:1194740605
Name:SUAREZ, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SUAREZ-CEDENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3201 UNIVERSITY DR E STE 425
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3479
Mailing Address - Country:US
Mailing Address - Phone:979-690-4828
Mailing Address - Fax:979-690-4829
Practice Address - Street 1:3201 UNIVERSITY DR E STE 425
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3479
Practice Address - Country:US
Practice Address - Phone:979-690-4828
Practice Address - Fax:979-690-4829
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169010901Medicaid
TXP00471011OtherMEDICARE RAILROAD
TX8B7581OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX8B7581OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX8C6516Medicare PIN