Healthcare Provider Details

I. General information

NPI: 1306190889
Provider Name (Legal Business Name): ELLIOTT SOLOMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 WHITE CEDAR LANE
DELRAY BEACH FL
33445
US

IV. Provider business mailing address

4381 WHITE CEDAR LANE
DELRAY BEACH FL
33445
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-5790
  • Fax: 815-301-8260
Mailing address:
  • Phone: 561-638-5790
  • Fax: 815-301-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number087675-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: