Healthcare Provider Details

I. General information

NPI: 1558342626
Provider Name (Legal Business Name): JODI S ELLIOTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 PROVIDENCE DR STE 500
ANCHORAGE AK
99508-4628
US

IV. Provider business mailing address

3340 PROVIDENCE DR STE 500
ANCHORAGE AK
99508-4628
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2423
  • Fax: 907-563-1170
Mailing address:
  • Phone: 907-562-2423
  • Fax: 907-563-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5743
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1846375
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST HEALTH PLAN
# 2
Identifier128703
Identifier TypeOTHER
Identifier State
Identifier IssuerU CARE
# 3
Identifier1017253
Identifier TypeOTHER
Identifier State
Identifier IssuerPREFERRED ONE
# 4
IdentifierHP26565
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTH PARTNERS
# 5
IdentifierCOMP
Identifier TypeOTHER
Identifier State
Identifier IssuerMMSI
# 6
Identifier370022650
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE
# 7
Identifier1202554
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICA HEALTH PLANS
# 8
Identifier787139
Identifier TypeOTHER
Identifier State
Identifier IssuerARAZ GROUP AMERICAS PPO
# 9
Identifier293R7EL
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS BLUE SHIELD
# 10
IdentifierCOMP
Identifier TypeOTHER
Identifier State
Identifier IssuerCHAMPUS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: