Healthcare Provider Details

I. General information

NPI: 1003005752
Provider Name (Legal Business Name): KIRK E. ELLIOTT, M.D. , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR KIRK ELLIOT 410 OLIVE ST.
ARNAUDVILLE LA
70512-0187
US

IV. Provider business mailing address

DR KIRK ELLIOTT PO BOX 187
ARNAUDVILLE LA
70512-0187
US

V. Phone/Fax

Practice location:
  • Phone: 337-754-7254
  • Fax: 337-754-8047
Mailing address:
  • Phone: 337-754-7254
  • Fax: 337-754-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number023075
License Number StateLA

VIII. Authorized Official

Name: KIRK EDWARD ELLIOTT
Title or Position: OWNER
Credential: M.D.
Phone: 337-754-7254