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Individual
JACK S ELDER
Active
Individual
JACK S ELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35-053721
OH
208800000X
Urology Physician
4301072611
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000026163
ANTHEM
OH
05
—
001953975002
—
PA
01
—
020H277290
BCBS
MI
05
—
0633587
—
OH
01
—
1396817714
GROUP NPI
MI
01
—
1900370
UHC
OH
05
—
5196618
—
MI
01
—
P00388789
RAILROAD MEDICARE
OH
Enumeration date
07/10/2006
Last updated
01/09/2013
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