Mark J Elder DO PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS8505 Issued in FL

Legal business name

MARK J ELDER DO PA

Practice address

3887 Scotts Plaza Dr
Jay, FL 32565-4001

Phone

(850) 981-0320

Fax

(850) 981-0911

NPI assigned

Nov 27, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lori Michele Elder

Title

Practice Manager

Phone

(850) 981-0320

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Heritage Family Medicine and Wellness Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1144651209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3887 SCOTTS PLAZA DR",
            "city": "JAY",
            "state": "FL",
            "postal_code": "325654001",
            "telephone_number": "850-981-0320",
            "fax_number": "850-981-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3887 SCOTTS PLAZA DR",
            "city": "JAY",
            "state": "FL",
            "postal_code": "325654001",
            "telephone_number": "850-981-0320",
            "fax_number": "850-981-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK J ELDER DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "ELDER",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "850-981-0320"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS8505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262643800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Family Medicine and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Jay, FL
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.