MEDICARE: WILLIAM R ELLIOTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	054178	GA
2	207Q00000X	Family Medicine Physician	054178	GA
3	207P00000X	Emergency Medicine Physician	ME 89642	FL
4	207Q00000X	Family Medicine Physician	ME 89642	FL
5	207Q00000X	Family Medicine Physician	35063580	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	93165	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1013981042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R ELLIOTT MD

Provider Business Mailing Address
First Line	:	1827 RIVA RIDGE DR
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44904-2127
Country	:	US
Telephone Number	:	419-617-4452
Fax Number	:	419-617-1080

Provider Business Practice Location Address
First Line	:	1827 RIVA RIDGE DR
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44904-2127
Country	:	US
Telephone Number	:	419-617-4452
Fax Number	:	419-617-1080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/17/2014

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Directions to “ WILLIAM R ELLIOTT MD” Practice Location

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