Provider Demographics
NPI:1639175797
Name:KANAAN, ELIAS T (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:T
Last Name:KANAAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W PARK STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8337
Mailing Address - Country:US
Mailing Address - Phone:936-328-5820
Mailing Address - Fax:936-328-5824
Practice Address - Street 1:210 W PARK STE 104
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8337
Practice Address - Country:US
Practice Address - Phone:936-328-5820
Practice Address - Fax:936-328-5824
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3270207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00234310OtherMEDICARE RAILROAD PIN
TX047563402Medicaid
TX0002MTOtherBCBS INDIVIDUAL
TX8F0730Medicare PIN
TX047563402Medicaid