Provider Demographics
NPI:1104871631
Name:DRELL, ELIOT ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:ROBERT
Last Name:DRELL
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 1:1006 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-622-6430
Mailing Address - Fax:530-622-3957
Practice Address - Street 1:1006 MARSHALL WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5706
Practice Address - Country:US
Practice Address - Phone:530-622-6430
Practice Address - Fax:530-622-3957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048710Medicaid
CAZZZ22929ZMedicare ID - Type UnspecifiedMCARE-PV ADDRESS
CAZZZ20819ZMedicare ID - Type UnspecifiedMCARE FOLSOM ADDRESS
CAGR0048710Medicaid