MEDICARE: THOMAS M. ELDER III 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	207RC0000X	Cardiovascular Disease Physician	GFE25277	CA

General Provider Information

NPI Number	:	1477564466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M. ELDER III M.D.

Provider Business Mailing Address
First Line	:	19887 JUNIPER RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-8713
Country	:	US
Telephone Number	:	760-247-8411
Fax Number	:	760-247-8411

Provider Business Practice Location Address
First Line	:	19887 JUNIPER RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-8713
Country	:	US
Telephone Number	:	760-247-8411
Fax Number	:	760-247-8411

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	03/22/2026

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