Provider Demographics
NPI:1164488953
Name:ELIAS, BARBARA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E WILD ELK TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7941
Mailing Address - Country:US
Mailing Address - Phone:928-580-8886
Mailing Address - Fax:
Practice Address - Street 1:4545 E WILD ELK TRL
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7941
Practice Address - Country:US
Practice Address - Phone:928-580-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0516938OtherDEA
AZP51048Medicare UPIN
AZ105562Medicare ID - Type Unspecified