Healthcare Provider Details

I. General information

NPI: 1245335231
Provider Name (Legal Business Name): DIANA L ELIAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/06/2014
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: 727-327-7877
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:
Title or Position:
Credential:
Phone: