Provider Demographics
NPI:1346356029
Name:ELDER, STEPHANIE J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
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 1:5220 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:727-867-5480
Mailing Address - Fax:888-507-9833
Practice Address - Street 1:5220 BELFORT RD
Practice Address - Street 2:STE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6017
Practice Address - Country:US
Practice Address - Phone:727-867-5480
Practice Address - Fax:888-507-9833
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0086077207PE0005X
FLME860772083P0011X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92628OtherBCBS
P00086589OtherRAILROAD MEDICARE
FL7788558OtherAETNA
FL267690700Medicaid
FL7788558OtherAETNA
FL267690700Medicaid