Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 36001546E | OH |
NPI | 1033190665 |
---|---|
Provider Name | Cameron A. Elliott |
First Address | Cuyahoga Falls, OH 44223-1427 |
Second Address | Cuyahoga Falls, OH 44223-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0147326 | (05) | OH |
P00413731 | MEDICARE RR (01) | OH |
T80351 | (02) | OH |