Provider Demographics
NPI:1710971478
Name:ELLIOTT, STEPHEN C (DO PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:ELLIOTT
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Gender:M
Credentials:DO PHD
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Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1453
Mailing Address - Country:US
Mailing Address - Phone:515-241-6000
Mailing Address - Fax:515-241-8728
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1453
Practice Address - Country:US
Practice Address - Phone:515-241-6000
Practice Address - Fax:515-241-8728
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA15782080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1710971478Medicaid
IA1710971478Medicaid
175150071OtherMEDICARE
A01272Medicare UPIN