Provider Demographics
NPI:1083649115
Name:MCELROY, GEORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:MCELROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 AMERICAN AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1079
Mailing Address - Country:US
Mailing Address - Phone:573-761-7210
Mailing Address - Fax:573-634-8802
Practice Address - Street 1:3348 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1079
Practice Address - Country:US
Practice Address - Phone:573-761-7210
Practice Address - Fax:573-634-8802
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200951408Medicaid
MO004013186Medicare ID - Type Unspecified
MO200951408Medicaid