Individual
MICHAEL CHAD ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200859940A
—
OK
01
—
P02599432
RR MCR
TX
Enumeration date
10/23/2018
Last updated
02/26/2025
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