Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 13923 | AZ |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 13923 | AZ |
NPI | 1255300802 |
---|---|
Provider Name | John Palmer Elliott |
First Address | Mesa, AZ 85202-4704 |
Second Address | Mesa, AZ 85202-4704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
229692 | (05) | AZ |
A46643 | (02) | AZ |