Healthcare Provider Details

I. General information

NPI: 1003014168
Provider Name (Legal Business Name): JOHN M ELLIOTT C.S.F.A./D.O./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S CENTRAL EXPY STE 130
MCKINNEY TX
75070-4068
US

IV. Provider business mailing address

3201 MID DALE LN
LOUISVILLE KY
40220-2615
US

V. Phone/Fax

Practice location:
  • Phone: 972-363-8200
  • Fax: 972-363-8195
Mailing address:
  • Phone: 502-599-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number107788
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA170
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberFFF/11/296
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: