Provider Demographics
NPI:1215087143
Name:ELLIOTT, THOMAS R (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1980 W HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7805
Mailing Address - Country:US
Mailing Address - Phone:520-742-9062
Mailing Address - Fax:520-797-8627
Practice Address - Street 1:1980 W HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7805
Practice Address - Country:US
Practice Address - Phone:520-742-9062
Practice Address - Fax:520-797-8627
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11650208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234823Medicaid
AZP00998677OtherMEDICARE RAIL ROAD
AZ234823Medicaid
AZZ$$$$$$$$$Medicare PIN