Provider Demographics
NPI:1699723973
Name:ELLIOTT, JOHN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7550 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7607
Mailing Address - Country:US
Mailing Address - Phone:352-727-4911
Mailing Address - Fax:352-505-5211
Practice Address - Street 1:7550 W UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7607
Practice Address - Country:US
Practice Address - Phone:352-727-4911
Practice Address - Fax:352-505-5211
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME276742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052291100Medicaid
FL48871OtherBCBSFL
FL270855OtherAVMED
FLP0032923OtherRAIL ROAD MEDICARE
FL239216OtherAVMED
FLP00316726OtherRAIL ROAD MEDICARE
FLP00316726OtherRAIL ROAD MEDICARE
FL270855OtherAVMED
FLD64239Medicare UPIN