Healthcare Provider Details

I. General information

NPI: 1679511026
Provider Name (Legal Business Name): ELLIOT EMILE KURBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELLIOT EMILE KURBAN MD

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MURRAY GUARD DR
JACKSON TN
38305-3661
US

IV. Provider business mailing address

58 MURRAY GUARD DR
JACKSON TN
38305-3661
US

V. Phone/Fax

Practice location:
  • Phone: 731-513-5701
  • Fax: 877-867-6701
Mailing address:
  • Phone: 731-513-5701
  • Fax: 877-867-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36932
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: