Provider Demographics
NPI:1750505087
Name:ELLIOTT, WAYNE GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GORDON
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 PARADISE HARBOUR BLVD
Mailing Address - Street 2:APT. 202
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5045
Mailing Address - Country:US
Mailing Address - Phone:870-918-9313
Mailing Address - Fax:
Practice Address - Street 1:105 PARADISE HARBOUR BLVD
Practice Address - Street 2:APT. 202
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5045
Practice Address - Country:US
Practice Address - Phone:870-918-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-1940207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology