Provider Demographics
NPI:1225685118
Name:MCELROY, MATTHEW LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LYNN
Last Name:MCELROY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19251 E OASIS DR
Mailing Address - Street 2:
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-8878
Mailing Address - Country:US
Mailing Address - Phone:623-374-0200
Mailing Address - Fax:
Practice Address - Street 1:19251 E OASIS DR
Practice Address - Street 2:
Practice Address - City:BLACK CANYON CITY
Practice Address - State:AZ
Practice Address - Zip Code:85324-8878
Practice Address - Country:US
Practice Address - Phone:623-374-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty