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General NPI Number Information
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NPI Number | 1184724718
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Entity Type | Individual
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Provider Name | MARK STEVEN ELLIOTT MD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 5002 HIGHWAY 39 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1078
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Country | US
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Telephone | 601-880-3850
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Fax | 601-693-7758
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Provider Business Mailing Address
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Address Line | 4612 29TH AVE
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City | MERIDIAN
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State | MS
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Zip | 39305-1652
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Country | US
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Telephone | 601-512-0431
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Fax | 601-482-5065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 16268
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16268
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License Number State | MS
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