Provider Demographics
NPI:1477559409
Name:ELDER, MARK JAMES (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:ELDER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3887 SCOTTS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-4001
Mailing Address - Country:US
Mailing Address - Phone:850-981-0320
Mailing Address - Fax:850-981-0911
Practice Address - Street 1:3887 SCOTTS PLAZA DR
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-4001
Practice Address - Country:US
Practice Address - Phone:850-981-0320
Practice Address - Fax:850-981-0911
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263360638OtherTAX ID
AL590-48269OtherBCBS
FL05247OtherBLUE CROSS FLORIDA
FLHS620AOtherMEDICARE GROUP PTAN
FL262643800Medicaid
F92324Medicare UPIN
AL590-48269OtherBCBS