Provider Demographics
NPI:1043396955
Name:ELLIOTT, ALEX DESHAUN
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:DESHAUN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRUMBO RD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6655
Mailing Address - Country:US
Mailing Address - Phone:305-292-8715
Mailing Address - Fax:305-292-7523
Practice Address - Street 1:100 TRUMBO RD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6655
Practice Address - Country:US
Practice Address - Phone:305-292-8715
Practice Address - Fax:305-292-7523
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other