Provider Demographics
NPI:1902960123
Name:EBILANE, ELIZABETH BABASA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BABASA
Last Name:EBILANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:SUBIC BAY FREEPORT ZONE
Mailing Address - City:OLONGAPO CITY
Mailing Address - State:ZAMBALES
Mailing Address - Zip Code:2000
Mailing Address - Country:PH
Mailing Address - Phone:6347-223-7664
Mailing Address - Fax:6347-232-5245
Practice Address - Street 1:430 NATIONAL HI WAY
Practice Address - Street 2:BO BARRETTO
Practice Address - City:OLONGAPO CITY
Practice Address - State:ZAMBALES
Practice Address - Zip Code:2200
Practice Address - Country:PH
Practice Address - Phone:6347-223-7664
Practice Address - Fax:6347-232-5245
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI68080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIPHL002415OtherTRICARE
WIPHL009321OtherTRICARE