Provider Demographics
NPI:1306931803
Name:ELTON, JEFFREY M (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:ELTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19801 SE 7TH WAY
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-910-9400
Mailing Address - Fax:
Practice Address - Street 1:19801 SE 7TH WAY
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:360-910-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant