Healthcare Provider Details

I. General information

NPI: 1255300802
Provider Name (Legal Business Name): JOHN PALMER ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W SOUTHERN AVE
MESA AZ
85202-4704
US

IV. Provider business mailing address

2242 W SOUTHERN AVE
MESA AZ
85202-4704
US

V. Phone/Fax

Practice location:
  • Phone: 480-756-6000
  • Fax: 855-636-8770
Mailing address:
  • Phone: 480-756-0000
  • Fax: 855-636-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13923
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number13923
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: