Provider Demographics
NPI:1134114796
Name:ELLIOTT, BRIAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8506
Mailing Address - Country:US
Mailing Address - Phone:727-321-3854
Mailing Address - Fax:727-327-7670
Practice Address - Street 1:3251 3RD AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8506
Practice Address - Country:US
Practice Address - Phone:727-321-3854
Practice Address - Fax:727-327-7670
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32692207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037058400Medicaid
FL037058400Medicaid
FLD57307Medicare UPIN