MEDICARE: JOSEPH WAYNE ELIO 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	363AM0700X	Medical Physician Assistant	362	WY
2	363A00000X	Physician Assistant	4388	AZ

General Provider Information

NPI Number	:	1942240866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WAYNE ELIO PA

Provider Business Mailing Address
First Line	:	PO BOX 1808
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322
Country	:	US
Telephone Number	:	928-649-6477
Fax Number	:	877-441-6809

Provider Business Practice Location Address
First Line	:	348 S MAIN ST
Second Line	:
City	:	CAMP VERDE
State	:	AZ
Zip	:	86322
Country	:	US
Telephone Number	:	928-649-6477
Fax Number	:	877-441-6809

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/29/2020

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