Provider Demographics
NPI:1831133263
Name:ELLIOTT, JOHN THOMAS (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
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Mailing Address - Street 1:5644 MIDDLEFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-9702
Mailing Address - Country:US
Mailing Address - Phone:910-988-8359
Mailing Address - Fax:910-907-9360
Practice Address - Street 1:ROBINSON HEALTH CLINIC
Practice Address - Street 2:BLDG. C-3031 GRUBER RD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9396
Practice Address - Fax:910-907-9360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant