Provider Demographics
NPI:1396034559
Name:ELLIOTT, MARK RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RANDALL
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-494-9002
Mailing Address - Fax:850-477-3912
Practice Address - Street 1:4521 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2770
Practice Address - Country:US
Practice Address - Phone:850-494-9002
Practice Address - Fax:850-477-3912
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME131670207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery