Basic Information
| Provider Information | |||||||||
| NPI: | 1528017084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | CLINT | ||||||||
| MiddleName: | EVERETT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 JEFFERSON HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1514 JEFFERSON HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD200494 | LA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD.200494 | LA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 36697 | IA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | ME98633 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 24014 | 01 | IA | WELLMARK BCBS | OTHER | 278323100 | 05 | FL | MEDICAID | 05353549 | 05 | MS | MEDICAID | 1049930 | 05 | LA | MEDICAID | 0727586 | 05 | IA | MEDICAID |