Provider Demographics
NPI:1679511026
Name:KURBAN, ELLIOT EMILE (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:EMILE
Last Name:KURBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELLIOT
Other - Middle Name:EMILE
Other - Last Name:KURBAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:58 MURRAY GUARD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3661
Mailing Address - Country:US
Mailing Address - Phone:731-513-5701
Mailing Address - Fax:877-867-6701
Practice Address - Street 1:58 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3661
Practice Address - Country:US
Practice Address - Phone:731-513-5701
Practice Address - Fax:877-867-6701
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36932207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10306I2080OtherMEDICARE
TNP01778643OtherRAILROAD MEDICARE
TNQ010250Medicaid
TN4055233OtherBLUE CROSS/BLUE SHIELD
TN3880012Medicare ID - Type Unspecified
P00261737OtherRAILROAD MEDICARE