Individual
MR. ANTHONY WAYNE ELLIOTT II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
KCSA
Contact information
Practice address
3300 JUSTINIAN, JEFFERSONVILLE, IN 47130-8630
(502) 523-6317
(812) 288-1119
Mailing address
3300 JUSTINIAN, JEFFERSONVILLE, IN 47130-8630
(502) 523-6317
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA102
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000628536
ANTHEM BC/BS
KY
Enumeration date
04/23/2007
Last updated
10/04/2018
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