Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | J6104 | TX |
N | 2086S0129X | Vascular Surgeon | J6104 | TX |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | J6104 | TX |
NPI | 1114993060 |
---|---|
Provider Name | Dr. Louis Woodrow Elkins JR. |
First Address | Saint Louis, MO 63195-8539 |
Second Address | Mountain Home, AR 72653-2946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131212001 | (05) | AR |
157760002 | (05) | AR |
F83515 | (02) | AR |