Provider Demographics
NPI:1801876669
Name:ELLIOTT, PAUL A (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2229
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-2229
Mailing Address - Country:US
Mailing Address - Phone:772-288-6300
Mailing Address - Fax:772-288-6374
Practice Address - Street 1:506 SW FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2827
Practice Address - Country:US
Practice Address - Phone:772-288-6300
Practice Address - Fax:772-288-6374
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS63512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F53002Medicare UPIN