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NPI Code Detail

MEDICARE: IVAN J ELIAS MD

MEDICARE: IVAN J ELIAS MD
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
1207RG0100XGastroenterology PhysicianME159213FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3110126494OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255337879
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVAN J ELIAS MD
Provider Business Mailing Address
First Line : PO BOX 732892
Second Line :
City : DALLAS
State : TX
Zip : 75373-1149
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 125 BAPTIST WAY STE 4C
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-2254
Country : US
Telephone Number : 850-626-9626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 09/19/2023

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