Provider Demographics
NPI:1689670010
Name:ELLIOTT, LAWRENCE JAMES (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JAMES
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 VENETIA BAY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8044
Mailing Address - Country:US
Mailing Address - Phone:941-497-5511
Mailing Address - Fax:941-492-2221
Practice Address - Street 1:901 VENETIA BAY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8044
Practice Address - Country:US
Practice Address - Phone:941-497-5511
Practice Address - Fax:941-492-2221
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007414207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257322900Medicaid
FL56746Medicare ID - Type Unspecified
FL257322900Medicaid