Provider Demographics
NPI:1407030042
Name:ELIAS RADIOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:ELIAS RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-1720
Mailing Address - Street 1:10420 SW 77 AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3771
Mailing Address - Country:US
Mailing Address - Phone:305-661-1720
Mailing Address - Fax:305-661-1652
Practice Address - Street 1:10420 SW 77TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3771
Practice Address - Country:US
Practice Address - Phone:305-661-1720
Practice Address - Fax:305-661-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME37821OtherLIC NUMBER
FLD14611Medicare UPIN