Provider Demographics
NPI:1356332928
Name:GEVIS, ELLIOT L (DO)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:L
Last Name:GEVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 MEMPHIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4510
Mailing Address - Country:US
Mailing Address - Phone:215-426-5566
Mailing Address - Fax:215-739-3904
Practice Address - Street 1:3380 MEMPHIS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4510
Practice Address - Country:US
Practice Address - Phone:215-426-5566
Practice Address - Fax:215-739-3904
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006045L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics