Provider Demographics
NPI:1073573911
Name:ELLIOTT, BOBBY L (DO)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-573-5400
Mailing Address - Fax:405-573-5406
Practice Address - Street 1:700 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6232
Practice Address - Country:US
Practice Address - Phone:405-573-5400
Practice Address - Fax:405-573-5406
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E45373Medicare UPIN