Healthcare Provider Details

I. General information

NPI: 1073906202
Provider Name (Legal Business Name): DAVID O. ELLIOTT M.D.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W DIXIE AVE SUITE B
LEESBURG FL
34748-6380
US

IV. Provider business mailing address

1218 W DIXIE AVE STE B
LEESBURG FL
34748-6380
US

V. Phone/Fax

Practice location:
  • Phone: 352-326-5132
  • Fax: 352-326-3315
Mailing address:
  • Phone: 352-326-5132
  • Fax: 352-326-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME38031
License Number StateFL

VIII. Authorized Official

Name: DR. EVA YOLANDA ELLIOTT
Title or Position: OFFICE MANAGER
Credential: PHD
Phone: 352-326-5132