Provider Demographics
NPI:1730152760
Name:ELLIOTT, DENISE LEA (DPM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LEA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:N507
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6633
Mailing Address - Fax:504-349-6631
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:N507
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6633
Practice Address - Fax:504-349-6631
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD228R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431206Medicaid
LA480030460Medicare PIN
LA1431206Medicaid