Provider Demographics
NPI:1487663274
Name:SCOTT R. ELKIN, DO, PA
Entity Type:Organization
Organization Name:SCOTT R. ELKIN, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-306-0061
Mailing Address - Street 1:PO BOX 4595
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4595
Mailing Address - Country:US
Mailing Address - Phone:512-306-0061
Mailing Address - Fax:512-306-0069
Practice Address - Street 1:1510 W 34TH ST STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1494
Practice Address - Country:US
Practice Address - Phone:512-306-0061
Practice Address - Fax:512-306-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG16442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3207OtherMEDICARE PTAN
TX1487663274OtherNPI
TX1487663274OtherBCBS NPI - GROUP