MEDICARE: RONALD ELLER PA

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	363A00000X	Physician Assistant	PA033	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	413906650	OTHER	MS	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518992833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ELLER PA

Provider Business Mailing Address
First Line	:	PO BOX 23666
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39225-3666
Country	:	US
Telephone Number	:	601-200-4749
Fax Number	:	601-200-5929

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR STE 657
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4608
Country	:	US
Telephone Number	:	601-200-2780
Fax Number	:	601-200-2788

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/26/2019

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Directions to “ RONALD ELLER PA” Practice Location

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