Provider Demographics
NPI:1124081971
Name:ELLIOTT, JAMES RANDALL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDALL
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 AMDS/SGP
Mailing Address - Street 2:55 N. WOLFE AVE.
Mailing Address - City:EDWARDS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93524-0001
Mailing Address - Country:US
Mailing Address - Phone:661-277-1130
Mailing Address - Fax:661-277-0688
Practice Address - Street 1:95 AMDS/SGP
Practice Address - Street 2:55 N. WOLFE AVE.
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-0001
Practice Address - Country:US
Practice Address - Phone:661-277-1130
Practice Address - Fax:661-277-0688
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-2302083A0100X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine