Provider Demographics
NPI:1861608929
Name:PEARCH, ELIZABETH A (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:PEARCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4951 LONG PRAIRIE ROAD, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-691-9190
Mailing Address - Fax:972-691-3841
Practice Address - Street 1:4951 LONG PRAIRIE ROAD, SUITE 120
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-691-9190
Practice Address - Fax:972-691-3841
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203724401Medicaid
TX203724403Medicaid
TX203724402Medicaid
TX8L16569Medicare PIN
TX203724403Medicaid
TX8L16518Medicare PIN
TX8L16517Medicare PIN
TX203724401Medicaid
TXTXB121927Medicare PIN