# JACK S ELDER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1457385072
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 35-053721 | OH | Yes |
| 208800000X | Urology Physician | 4301072611 | MI | — |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 01/09/2013

## 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 |