Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 23506 | WV |
NPI | 1164545000 |
---|---|
Provider Name | Dr. Michael Elmore |
First Address | Charleston, WV 25304-1210 |
Second Address | Charleston, WV 25304-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810018913 | (05) | WV |