Elliott, Wendell H

Elliott, Wendell H is an individual health care provider with primary practice located at 686 Lester St , Poplar Bluff MO 63901-5025. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Elliott, Wendell H can be contacted via phone (573) 686-2411.

Contact Information

Primary practice address
686 Lester St Poplar Bluff MO 63901-5025
Phone: (573) 686-2411
Fax: (573) 686-8452
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R5G12 Missouri

Profile Details

NPI number 1730168592
LBN Legal business name Elliott, Wendell H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2006
Last updated Nov 5th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730168592 NPPES
Arkansas MEDICAID 113765001
Arkansas Other 080037682
Arkansas MEDICAID 20Z414900

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