Provider Demographics
NPI:1609176817
Name:PAUL A ELLIOTT DO PA
Entity Type:Organization
Organization Name:PAUL A ELLIOTT DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-288-6300
Mailing Address - Street 1:PO BOX 2229
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-2229
Mailing Address - Country:US
Mailing Address - Phone:772-288-6300
Mailing Address - Fax:772-288-6374
Practice Address - Street 1:506 SW FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2827
Practice Address - Country:US
Practice Address - Phone:772-224-2221
Practice Address - Fax:772-288-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6351174400000X
174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF53002Medicare UPIN