Provider Demographics
NPI:1861491979
Name:ELMQUIST, ERIC TREVOR (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TREVOR
Last Name:ELMQUIST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12670 NEW BRITTANY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3650
Mailing Address - Country:US
Mailing Address - Phone:239-936-2020
Mailing Address - Fax:239-936-2776
Practice Address - Street 1:12670 NEW BRITTANY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3650
Practice Address - Country:US
Practice Address - Phone:239-936-2020
Practice Address - Fax:239-936-2776
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBE1550056OtherDEA NUMBER
FLBE1550056OtherDEA NUMBER
FLE72167Medicare UPIN