Healthcare Provider Details

I. General information

NPI: 1760708002
Provider Name (Legal Business Name): ELLIOT W. CAUBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD SUITE 206
RIVERVIEW FL
33578-7419
US

IV. Provider business mailing address

10141 BIG BEND RD STE 206
RIVERVIEW FL
33578-7422
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-1274
  • Fax: 813-397-1271
Mailing address:
  • Phone: 813-397-1274
  • Fax: 813-605-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number164638
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME124576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: