Healthcare Provider Details

I. General information

NPI: 1003187238
Provider Name (Legal Business Name): DIANA L. ELIAS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CENTRAL AVE
ST PETERSBURG FL
33711-1238
US

IV. Provider business mailing address

3900 CENTRAL AVE
ST PETERSBURG FL
33711-1238
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-7277
  • Fax:
Mailing address:
  • Phone: 727-327-7277
  • Fax: 727-327-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0059542
License Number StateFL

VIII. Authorized Official

Name: DR. DIANA L ELIAS
Title or Position: OWNER
Credential: M.D.
Phone: 727-327-7277