Individual
GERALD W. ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 N EAGLE CREEK DR, SUITE 360, LEXINGTON, KY 40509-1827
(859) 258-5270
(859) 258-5202
Mailing address
120 N EAGLE CREEK DR, SUITE 360, LEXINGTON, KY 40509-1827
(859) 258-5270
(859) 258-5202
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
26524
KY
207NP0225X
Pediatric Dermatology Physician
26524
KY
207NS0135X
Procedural Dermatology Physician
26524
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36000818
ASC MEDICAID LAB GROUP
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64265242
—
KY
01
—
ASC1019
ASC MEDICARE GROUP
KY
01
—
CB5773
RAILROAD MEDICARE GROUP
KY
Enumeration date
07/11/2006
Last updated
11/02/2007
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