Provider Demographics
NPI:1902289556
Name:MORISSEAU, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MORISSEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 UPLAND LKS
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4740
Mailing Address - Country:US
Mailing Address - Phone:718-614-6838
Mailing Address - Fax:
Practice Address - Street 1:1669 UPLAND LKS
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4740
Practice Address - Country:US
Practice Address - Phone:718-614-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty