Provider Demographics
NPI:1023002144
Name:GUROVA, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:GUROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-0770
Mailing Address - Country:US
Mailing Address - Phone:817-645-5915
Mailing Address - Fax:817-645-5935
Practice Address - Street 1:519 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3845
Practice Address - Country:US
Practice Address - Phone:817-645-5915
Practice Address - Fax:817-645-5935
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7404207R00000X
NM2002-0425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1056377OtherCLIA WAIVER NUMBER
TXJ0130220OtherTEXAS DPS NUMBER
TX158386603Medicaid
TXBG8114871OtherDEA NUMBER
TXJ0130220OtherTEXAS DPS NUMBER
TXBG8114871OtherDEA NUMBER
TX8F3896Medicare PIN