Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01034178 | IN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 01034178 | IN |
NPI | 1134335318 |
---|---|
Provider Name | Dr. Elton Amos |
First Address | Indianapolis, IN 46268-6129 |
Second Address | Indianapolis, IN 46268-6129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 01/11/2010 |