Healthcare Provider Details

I. General information

NPI: 1528158045
Provider Name (Legal Business Name): DAVID OWEN ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 WEST DIXIE AVE B
LEESBURG FL
34748
US

IV. Provider business mailing address

1218 WEST DIXIE AVE B
LEESBURG FL
34748
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 Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME 38031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: