Healthcare Provider Details

I. General information

NPI: 1760422034
Provider Name (Legal Business Name): DAVID CARLOS ELLIOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42024 HIGHWAY 195
HALEYVILLE AL
35565-7054
US

IV. Provider business mailing address

200 CORPORATE BLVD. SUITE 200
LAFAYETTE LA
70508
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-3283
  • Fax:
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00018150
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: