Provider Demographics
NPI:1083924278
Name:JEFFREY J ELSTON MD PA
Entity Type:Organization
Organization Name:JEFFREY J ELSTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-265-1108
Mailing Address - Street 1:616 E. ALTAMONTE DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-265-1109
Mailing Address - Fax:407-265-1514
Practice Address - Street 1:616 E. ALTAMONTE DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-265-1109
Practice Address - Fax:407-265-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 77929207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty