Provider Demographics
NPI:1518947100
Name:MONNOT, ELIZABETH S (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:MONNOT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2296
Mailing Address - Country:US
Mailing Address - Phone:918-286-6331
Mailing Address - Fax:
Practice Address - Street 1:503 S ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2296
Practice Address - Country:US
Practice Address - Phone:918-286-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3591207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100114220DMedicaid
H29455Medicare UPIN
OK100114220DMedicaid