Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2012-0192 | NC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2012-01920 | NC |
NPI | 1326039454 |
---|---|
Provider Name | Mr. John Daniel Elliott |
First Address | Elizabeth City, NC 27909-3473 |
Second Address | Elizabeth City, NC 27909-3473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 23/04/2021 |