Provider Demographics
NPI:1588640007
Name:COPE, LISE MORIN (MD)
Entity Type:Individual
Prefix:
First Name:LISE
Middle Name:MORIN
Last Name:COPE
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:ONE BAYLOR PLAZA
Mailing Address - Street 2:#286A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:713-948-7000
Mailing Address - Fax:
Practice Address - Street 1:700 E MARSHALL AVE.
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5580
Practice Address - Country:US
Practice Address - Phone:903-315-2403
Practice Address - Fax:903-315-1832
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5594174400000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
011265L84OtherMEDICARE - LGP
VA006600972OtherMEDICAID - LGP
VA010273714Medicaid
F36627Medicare UPIN