MEDICARE: JONATHAN ELLEMENT 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	207P00000X	Emergency Medicine Physician	SCMD52755	SC

General Provider Information

NPI Number	:	1275807919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ELLEMENT M.D.

Provider Business Mailing Address
First Line	:	9040 FITZSIMMONS DR
Second Line	:
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98431-1000
Country	:	US
Telephone Number	:	253-968-2997
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 CANNON ST STE 402
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8909
Country	:	US
Telephone Number	:	843-792-9707
Fax Number	:

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

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	05/09/2026

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