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Individual
MARK JAMES ELDER
Active
Individual
MARK JAMES ELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS8505
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05247
BLUE CROSS FLORIDA
FL
05
—
262643800
—
FL
01
—
263360638
TAX ID
FL
01
—
590-48269
BCBS
AL
01
—
HS620A
MEDICARE GROUP PTAN
FL
Enumeration date
06/23/2005
Last updated
05/04/2016
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