MEDICARE: DR. ROBERT MICHAEL ELLIOTT MD

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	207NS0135X	Procedural Dermatology Physician	G29258	CA

General Provider Information

NPI Number	:	1942479746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL ELLIOTT MD

Provider Business Mailing Address
First Line	:	3001 E TAHQUITZ CANYON WAY STE 104
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6900
Country	:	US
Telephone Number	:	760-832-5027
Fax Number	:	760-620-5085

Provider Business Practice Location Address
First Line	:	3001 E TAHQUITZ CANYON WAY STE 104
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6900
Country	:	US
Telephone Number	:	949-263-0800
Fax Number	:	657-304-0084

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	11/02/2020

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