Individual
ERIC THOMAS ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 322-1730
(208) 322-1731
Mailing address
2963 E COPPER POINT DR, SUITE 150, MERIDIAN, ID 83642-9055
(208) 322-1730
(208) 322-1731
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
29026
SC
207P00000X
Emergency Medicine Physician
Primary
M-10699
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1196079
MEDICARE ID
ID
05
—
808368700
—
ID
Enumeration date
03/09/2007
Last updated
09/25/2015
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