MEDICARE: DR. JAMISON WENDELL ELDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	34697	SC

General Provider Information

NPI Number	:	1194714162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMISON WENDELL ELDER M.D.

Provider Business Mailing Address
First Line	:	1202 CHANTILLY CIR
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-4323
Country	:	US
Telephone Number	:	803-840-0825
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 BOATNER RD
Second Line	:
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1302
Country	:	US
Telephone Number	:	803-840-0825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	10/13/2023

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