| Doctor Name: | DR. JAMISON WENDELL ELDER |
| NPI Number: | 1194714162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | L6369 |
| Business Practice Address: | 11019 Javalin Trl Helotes, TX - 780234294 |
| Business Phone Number: | 2106959972 |
| Business Fax Number: | 2102927986 |
| Mailing Address: | 11019 Javalin Trl, HELOTES |
| State: | TX |
| Postal Code: | 780234294 |
| Phone Number: | 2106959972 |
| Fax Number: | 2102927986 |
| NPI Enumeration Date: | 10/20/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | L6369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |