Provider Demographics
NPI:1003133653
Name:ELY, ERIN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELIZABETH
Last Name:ELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1300 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2718
Mailing Address - Country:US
Mailing Address - Phone:314-622-4971
Mailing Address - Fax:314-977-7615
Practice Address - Street 1:1300 CLARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2718
Practice Address - Country:US
Practice Address - Phone:314-622-4971
Practice Address - Fax:314-977-7615
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016011683207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology