Provider Demographics
NPI:1144405184
Name:J RAEL ELK, MD
Entity Type:Organization
Organization Name:J RAEL ELK, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:RAEL
Authorized Official - Last Name:ELK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-9621
Mailing Address - Street 1:PO BOX 19529
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77224-9529
Mailing Address - Country:US
Mailing Address - Phone:713-464-9621
Mailing Address - Fax:
Practice Address - Street 1:921 GESSNER RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:713-464-9621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00682NMedicare PIN