Provider Demographics
NPI:1538386701
Name:ELIZABETH LOUDON, MD PA
Entity type:Organization
Organization Name:ELIZABETH LOUDON, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-9494
Mailing Address - Street 1:7434 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4538
Mailing Address - Country:US
Mailing Address - Phone:210-615-9494
Mailing Address - Fax:210-615-1514
Practice Address - Street 1:7434 LOUIS PASTEUR DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4538
Practice Address - Country:US
Practice Address - Phone:210-615-9494
Practice Address - Fax:210-615-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6161207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG25890Medicare UPIN
TX0020BNMedicare ID - Type Unspecified