Provider Demographics
NPI:1639259898
Name:MORRISON-BANKS, ELIZABETH HART (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HART
Last Name:MORRISON-BANKS
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:HART
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1501 VIOLET ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1603
Mailing Address - Country:US
Mailing Address - Phone:909-498-0687
Mailing Address - Fax:951-717-8609
Practice Address - Street 1:4646 BROCKTON AVE STE 302-2
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0174
Practice Address - Country:US
Practice Address - Phone:951-742-5255
Practice Address - Fax:951-717-8609
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG795452084N0400X
CA000000G79545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37061Medicare UPIN