Jack D Elder, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

D2419 Issued in TX

Practice address

709 Hollybrook Dr
Suite 3401
Longview, TX 75605-2411

Phone

(903) 753-1778

Fax

(903) 753-7202

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longview Specialty Physicians

  • Durable Medical Equipment & Medical Supplies
  • Longview, TX
  • NPI 1306063490
  NPD (past)

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1184691792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847176",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847176",
            "telephone_number": "903-237-1800",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HOLLYBROOK DR",
            "address_2": "SUITE 3401",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052411",
            "telephone_number": "903-753-1778",
            "fax_number": "903-753-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDER",
        "first_name": "JACK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "TX",
            "license": "D2419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Udeme Ekpenyong, MD
• Chigbo Nnanna Ekwueme, PHARM.D
• Sherif Elbarnashawy, BDS, MSD
• Ahmed A Elbira, DDS
• Elder Chiropractic Clinic
• Elevate Healthcare - Longview LLC
• Baher M Elhalwagi, MD
• Elite Spine Services PLLC
• Elizabeth Breedlove Family Practice & Aesthetics
• Ross-Jordon Elliott, M.D.

• Sports Medicine (Orthopaedic Surgery) Physician in Longview, TX
• Providers in Longview, TX by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; 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.