Healthcare Provider Details

I. General information

NPI: 1346291341
Provider Name (Legal Business Name): JEFFREY JAMES ELSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E ALTAMONTE DR SUITE 203
ALTAMONTE SPRINGS FL
32701-4823
US

IV. Provider business mailing address

616 E ALTAMONTE DR SUITE 203
ALTAMONTE SPRINGS FL
32701-4823
US

V. Phone/Fax

Practice location:
  • Phone: 407-265-1109
  • Fax: 407-265-1514
Mailing address:
  • Phone: 407-265-1109
  • Fax: 407-265-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME 77929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: