Provider Demographics
NPI:1215159447
Name:ELLIOTT, JON ZACHARY (DO)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:ZACHARY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12087
Mailing Address - Street 2:H088
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-2087
Mailing Address - Country:US
Mailing Address - Phone:757-867-6101
Mailing Address - Fax:757-867-6587
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:RIVERSIDE REGIONAL MEDICAL CENTER
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-4405
Practice Address - Fax:757-594-3547
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01022025762085R0202X
PAOT0113232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00897137OtherRAILROAD MEDICARE
VAP00897137OtherRAILROAD MEDICARE