Provider Demographics
NPI:1487665501
Name:MORVANT, ELISE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:MORVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6977 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3701
Mailing Address - Country:US
Mailing Address - Phone:713-797-1616
Mailing Address - Fax:713-793-3779
Practice Address - Street 1:6977 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-797-1616
Practice Address - Fax:713-793-3779
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35909207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4027847OtherBLUECROSS BLUESHIELD BLUE
KY64044985Medicaid
TN100037425OtherTENNCARE PHP
TN3899610Medicaid
KY64044985Medicaid