Provider Demographics
NPI:1336127331
Name:ELLIOTT, DAVID EDWARD JR (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:ELLIOTT
Suffix:JR
Gender:M
Credentials:RD, LD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:310 KAMEHAMEHA HWY APT 217
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5316
Mailing Address - Country:US
Mailing Address - Phone:210-454-4484
Mailing Address - Fax:808-433-2367
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07006133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered