Healthcare Provider Details

I. General information

NPI: 1972034478
Provider Name (Legal Business Name): ELISA MORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 JEFFERSON HWY
JEFFERSON LA
70121-2406
US

IV. Provider business mailing address

1319 JEFFERSON HWY
JEFFERSON LA
70121-2406
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3900
  • Fax:
Mailing address:
  • Phone: 504-842-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT2689
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number348423
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: