Provider Demographics
NPI:1710954185
Name:ELLIOTT, MAX A (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4007
Mailing Address - Country:US
Mailing Address - Phone:970-402-4501
Mailing Address - Fax:970-482-2635
Practice Address - Street 1:1200 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4007
Practice Address - Country:US
Practice Address - Phone:970-402-4501
Practice Address - Fax:970-482-2635
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1184993Medicaid
CO1184993Medicaid