Provider Demographics
NPI:1962460949
Name:ELLIOTT, ARVLE STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:ARVLE
Middle Name:STANLEY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 EDWARDS RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-336-4040
Mailing Address - Fax:817-336-6780
Practice Address - Street 1:5708 EDWARDS RANCH ROAD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-336-4040
Practice Address - Fax:817-336-6780
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4137102OtherAETNA
TX060464701Medicaid
TX130900704OtherMEDICAID EPSDT
TX83220XOtherBCBS
TX10028710OtherAMERIGROUP
TX4137102OtherAETNA