Healthcare Provider Details

I. General information

NPI: 1417963091
Provider Name (Legal Business Name): JAMES ELLIOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE PRESBYTERIAN HOSPITAL
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1100 CENTRAL AVE SE PRESBYTERIAN HOSPITAL
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-1309
  • Fax:
Mailing address:
  • Phone: 505-563-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number2004-0479
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: