Individual
JUDE REGAN ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
675 12TH ST SE, SALEM, OR 97301-4002
(503) 581-9191
Mailing address
675 12TH ST SE, SALEM, OR 97301-4002
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CPO1930
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1930
—
OR
Enumeration date
07/31/2017
Last updated
07/31/2017
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