Healthcare Provider Details

I. General information

NPI: 1942240866
Provider Name (Legal Business Name): JOSEPH WAYNE ELIO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 S MAIN ST
CAMP VERDE AZ
86322
US

IV. Provider business mailing address

PO BOX 1808
CAMP VERDE AZ
86322
US

V. Phone/Fax

Practice location:
  • Phone: 928-649-6477
  • Fax: 877-441-6809
Mailing address:
  • Phone: 928-649-6477
  • Fax: 877-441-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number362
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4388
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: