Provider Demographics
NPI:1528158045
Name:ELLIOTT, DAVID OWEN (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:OWEN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1218 WEST DIXIE AVE
Mailing Address - Street 2:B
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-326-5132
Mailing Address - Fax:352-326-3315
Practice Address - Street 1:1218 WEST DIXIE AVE
Practice Address - Street 2:B
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-326-5132
Practice Address - Fax:352-326-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 380312080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD45352Medicare UPIN