Provider Demographics
NPI:1063694057
Name:GEPPERT, ELENA GRANTCHAROVA (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:GRANTCHAROVA
Last Name:GEPPERT
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 1:3033 MARINA BAY DR.
Mailing Address - Street 2:STE. #110
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:281-334-3223
Mailing Address - Fax:282-334-4930
Practice Address - Street 1:3033 MARINA BAY DR.
Practice Address - Street 2:STE. #110
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-334-3223
Practice Address - Fax:282-334-4930
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL0221208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery