Provider Demographics
NPI:1558342626
Name:ELLIOTT, JODI S (DO)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4628
Mailing Address - Country:US
Mailing Address - Phone:907-562-2423
Mailing Address - Fax:907-563-1170
Practice Address - Street 1:3340 PROVIDENCE DR STE 500
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4628
Practice Address - Country:US
Practice Address - Phone:907-562-2423
Practice Address - Fax:907-563-1170
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1846375OtherFIRST HEALTH PLAN
128703OtherU CARE
1017253OtherPREFERRED ONE
HP26565OtherHEALTH PARTNERS
COMPOtherMMSI
370022650OtherRR MEDICARE
1202554OtherMEDICA HEALTH PLANS
787139OtherARAZ GROUP AMERICAS PPO
293R7ELOtherBLUE CROSS BLUE SHIELD
COMPOtherCHAMPUS
370022650OtherRR MEDICARE
1846375OtherFIRST HEALTH PLAN