Individual
IVAN J ELIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 BAPTIST WAY STE 4C, PENSACOLA, FL 32503-2254
(850) 626-9626
Mailing address
PO BOX 732892, DALLAS, TX 75373-1149
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME159213
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100321540A
—
KS
01
—
110126494
RR MEDICARE
—
05
—
209679000
—
MO
Enumeration date
06/28/2005
Last updated
09/19/2023
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