Individual
RICHARD LOWEN ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 SOUTH 11TH AVE, SUITE 206, POCATELLO, ID 83201
(208) 232-3480
(208) 233-6585
Mailing address
500 SOUTH 11TH AVE, SUITE 206, POCATELLO, ID 83201
(208) 232-3480
(208) 233-6585
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
GFE9724
CA
207W00000X
Ophthalmology Physician
Primary
M4909
ID
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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