Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 8344 | AZ |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 8344 | AZ |
NPI | 1164098570 |
---|---|
Provider Name | Elliot Dutton |
First Address | Chandler, AZ 85224-5249 |
Second Address | Phoenix, AZ 85019-4037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2021 |
Last Update Date | 05/06/2021 |