Basic Information
| Provider Information | |||||||||
| NPI: | 1518258433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JILES | ||||||||
| FirstName: | ELISICIA | ||||||||
| MiddleName: | LOUISE TAYLOR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VOLTZ | ||||||||
| OtherFirstName: | ELISICIA | ||||||||
| OtherMiddleName: | LOUISE TAYLOR | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1801 N BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788408001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307689200 | ||||||||
| FaxNumber: | 8307743534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 N BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788408001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307689200 | ||||||||
| FaxNumber: | 8307743534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD.32720 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.