Basic Information
| Provider Information | |||||||||
| NPI: | 1902856164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J B ELLIOT MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 SOUTH DR | ||||||||
| Address2: | STE 220 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488583256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897733411 | ||||||||
| FaxNumber: | 9897753187 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EDMORE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488298339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894273511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ELLIOT | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | BRUGLER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9894273511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301047281 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.