Provider Demographics
NPI:1467418871
Name:ELLER, SCOTT R (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:ELLER
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:PO BOX 440163
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0163
Mailing Address - Country:US
Mailing Address - Phone:615-848-2900
Mailing Address - Fax:615-848-2956
Practice Address - Street 1:237 W NORTHFIELD BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0531
Practice Address - Country:US
Practice Address - Phone:615-848-2900
Practice Address - Fax:615-848-2956
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH78667Medicare UPIN
TN3063161Medicare ID - Type Unspecified