Provider Demographics
NPI:1356313266
Name:ELTON, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:ELTON
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 1:11823 OLD GLENN HWY
Mailing Address - Street 2:STE. 104
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7734
Mailing Address - Country:US
Mailing Address - Phone:907-696-2273
Mailing Address - Fax:
Practice Address - Street 1:11823 OLD GLENN HWY
Practice Address - Street 2:STE. 104
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7734
Practice Address - Country:US
Practice Address - Phone:907-696-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD4482Medicaid
AKMD4482Medicaid
AK151716Medicare ID - Type Unspecified