MEDICARE: J B ELLIOT MD PC

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	207V00000X	Obstetrics & Gynecology Physician	4301047281	MI

General Provider Information

NPI Number	:	1902856164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J B ELLIOT MD PC

Provider Business Mailing Address
First Line	:	1201 SOUTH DR
Second Line	:	STE 220
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-3256
Country	:	US
Telephone Number	:	989-773-3411
Fax Number	:	989-775-3187

Provider Business Practice Location Address
First Line	:	1380 E MAIN ST
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-8339
Country	:	US
Telephone Number	:	989-427-3511
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERRY BRUGLER ELLIOT
Credential	:	M.D.
Telephone Number	:	989-427-3511

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/22/2020

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