MEDICARE: DR. KEVIN E ELDER M.D.

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	207Q00000X	Family Medicine Physician	ME81446	FL
2	207QS0010X	Sports Medicine (Family Medicine) Physician	ME81446	FL

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

General Provider Information

NPI Number	:	1598768160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN E ELDER M.D.

Provider Business Mailing Address
First Line	:	711 S DALE MABRY HWY STE 303
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4400
Country	:	US
Telephone Number	:	813-635-2107
Fax Number	:	813-605-6157

Provider Business Practice Location Address
First Line	:	711 S DALE MABRY HWY STE 303
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4400
Country	:	US
Telephone Number	:	813-635-2107
Fax Number	:	813-605-6157

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/21/2022

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