Provider Demographics
NPI:1346260890
Name:ELDER, LANA (MD)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S SEWALLS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SEWALLS POINT
Mailing Address - State:FL
Mailing Address - Zip Code:34996-6319
Mailing Address - Country:US
Mailing Address - Phone:772-214-9444
Mailing Address - Fax:
Practice Address - Street 1:300 SE HOSPITAL AVE
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2338
Practice Address - Country:US
Practice Address - Phone:772-223-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104494207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001109400Medicaid
FLH25574OtherUPIN
FL0E06122032OtherMEDICARE