Provider Demographics
NPI:1750388526
Name:ELSON, NATHAN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROBERT
Last Name:ELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:N
Other - Middle Name:ROBERT
Other - Last Name:ELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 1170
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-828-9495
Mailing Address - Fax:310-828-4211
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 1170
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-828-9495
Practice Address - Fax:310-828-4211
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39356207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37122Medicare UPIN