Provider Demographics
NPI:1558364703
Name:ATLAS, ELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:ATLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5819 HIGHWAY 6
Mailing Address - Street 2:STE 330
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4070
Mailing Address - Country:US
Mailing Address - Phone:281-499-6300
Mailing Address - Fax:281-499-7180
Practice Address - Street 1:5819 HIGHWAY 6
Practice Address - Street 2:STE 330
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4070
Practice Address - Country:US
Practice Address - Phone:281-499-6300
Practice Address - Fax:281-499-7180
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4799208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA37682Medicare UPIN