Provider Demographics
NPI:1992067466
Name:GEORGE, ELISA OLIVER MCDANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:OLIVER MCDANIEL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:OLIVER MCDANIEL
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 CRANDON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1614
Mailing Address - Country:US
Mailing Address - Phone:305-674-2599
Mailing Address - Fax:
Practice Address - Street 1:836 PONCE DE LEON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3068
Practice Address - Country:US
Practice Address - Phone:305-441-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73273207R00000X
FLME123919207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME123919OtherMEDICAL LICENSE