Provider Demographics
NPI:1366806671
Name:REX, ELISE HULL (MD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:HULL
Last Name:REX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:CHRISTINA
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 HARRIS PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4130
Mailing Address - Country:US
Mailing Address - Phone:817-776-4722
Mailing Address - Fax:
Practice Address - Street 1:6100 HARRIS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4130
Practice Address - Country:US
Practice Address - Phone:817-776-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10055816207V00000X
TXS5660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology