Provider Demographics
NPI:1003928334
Name:MCELWAIN, DAVID LEROY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEROY
Last Name:MCELWAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2220 E 45TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4218
Mailing Address - Country:US
Mailing Address - Phone:918-742-5009
Mailing Address - Fax:918-742-1484
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:866-285-4381
Practice Address - Fax:918-712-9883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK148292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93331Medicare UPIN