Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 01902926 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 01902926 | IL |
NPI | 1114363579 |
---|---|
Provider Name | Dr. Anthony Mitchell Elger |
First Address | Bloomington, IL 61701-3515 |
Second Address | Bloomington, IL 61701-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 22/08/2019 |