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General NPI Number Information
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NPI Number | 1619142452
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Entity Type | Organization
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Legal Business Name | DEB ELLIOTT-PEARSON M.D., P.C.
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 516 BANK ST
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City | WALLACE
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State | ID
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Zip | 83873-2225
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Country | US
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Telephone | 208-752-3016
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Fax | 208-753-1001
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Provider Business Mailing Address
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Address Line | 516 BANK ST
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City | WALLACE
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State | ID
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Zip | 83873-2225
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Country | US
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Telephone | 208-752-3016
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Fax | 208-753-1001
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Authorized Official
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Title or Position | CEO
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Name | DR. DEBORAH LOIS ELLIOTT-PEARSON
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Credential | M.D.
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Telephone | 208-752-3016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M7469
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License Number State | ID
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