Provider Demographics
NPI:1235431198
Name:MCELROY, SAMARA EPPS (DO)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:EPPS
Last Name:MCELROY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:S
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:201 BJC SAINT PETERS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3386
Mailing Address - Country:US
Mailing Address - Phone:636-916-9615
Mailing Address - Fax:636-916-9850
Practice Address - Street 1:201 BJC SAINT PETERS DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3386
Practice Address - Country:US
Practice Address - Phone:636-916-9615
Practice Address - Fax:636-916-9850
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018036517207Q00000X
CODR.0052187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04787072Medicaid
CO04787072Medicaid
COP01634508Medicare PIN