Dr. Jack D Elder
Sports Medicine Orthopaedic Surgeon
709 Hollybrook Dr Suite 3401
Longview
, Texas 75605-2411
Dr. Jack D Elder
Sports Medicine Orthopaedic Surgeon
709 Hollybrook Dr Suite 3401
Longview
, Texas 75605-2411
(903) 237-1810
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About
Features
Specialties
- Sports Medicine Orthopaedic Surgeon
Languages spoken
- English
Location
First Address
- Dr. Jack D Elder
- Po Box 847176
- Dallas, TX
- Zip : 75284-7176
- Fax : (903) 237-1810
- Phone : (903) 237-1800
Second Address
- Dr. Jack D Elder
- 709 Hollybrook Dr Suite 3401
- Longview, TX
- Zip : 75605-2411
- Fax : (903) 753-7202
- Phone : (903) 753-1778
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D2419 | TX |
National Provider Identifier
| NPI | 1184691792 |
|---|---|
| Provider Name | Dr. Jack D Elder |
| First Address | Dallas, TX 75284-7176 |
| Second Address | Longview, TX 75605-2411 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/03/2006 |
| Last Update Date | 04/09/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| B87700 | (02) | TX |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.