Provider Demographics
NPI:1811986581
Name:ELLIOTT, DAVID A (DO)
Entity type:Individual
Prefix:
First Name:DAVID
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 1:622 SE CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3970
Mailing Address - Country:US
Mailing Address - Phone:772-288-1220
Mailing Address - Fax:772-288-5151
Practice Address - Street 1:16410 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-343-6202
Practice Address - Fax:239-437-8537
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6350207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373111100Medicaid
FL80761RMedicare PIN
FL373111100Medicaid