Individual
ELLIOT DANIEL BACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6425 NICOLLET AVE STE 202, RICHFIELD, MN 55423-1668
(612) 869-2086
Mailing address
2 CARLSON PKWY N STE 240, PLYMOUTH, MN 55447-4485
(763) 367-7110
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
12466
MN
363A00000X
Physician Assistant
Primary
12466
MN
Other
Enumeration date
06/19/2017
Last updated
03/01/2024
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