Provider Demographics
NPI:1942630637
Name:DAVID H ELLIOTT, M.D.
Entity Type:Organization
Organization Name:DAVID H ELLIOTT, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-425-9311
Mailing Address - Street 1:105 MILLS AVENUE SUITE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701
Mailing Address - Country:US
Mailing Address - Phone:505-425-9311
Mailing Address - Fax:505-425-9047
Practice Address - Street 1:105 MILLS AVE STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4169
Practice Address - Country:US
Practice Address - Phone:505-425-9311
Practice Address - Fax:505-425-9047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID H ELLIOTT, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00739363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0771OtherBLUE CROSS BLUE SHIELD