Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | C20010095 | DE |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | AS2593778E50 | NJ |
NPI | 1821223413 |
---|---|
Provider Name | Dr. Justin Lee Elder |
First Address | Lewes, DE 19958-4828 |
Second Address | Lewes, DE 19958-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 17/03/2021 |