Provider Demographics
NPI:1780784496
Name:TREST, ELIZABETH A (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:TREST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1020 22ND AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-703-1003
Mailing Address - Fax:601-703-1004
Practice Address - Street 1:2401 16TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3950
Practice Address - Country:US
Practice Address - Phone:601-482-4181
Practice Address - Fax:601-482-4017
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14713207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117979Medicaid
MS00117979Medicaid
F59708Medicare UPIN