Provider Demographics
NPI:1386855823
Name:ELVIR, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:ELVIR
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 1:319 W TOWN PL
Mailing Address - Street 2:SUITE#1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3101
Mailing Address - Country:US
Mailing Address - Phone:904-940-1577
Mailing Address - Fax:904-940-1916
Practice Address - Street 1:319 W TOWN PL
Practice Address - Street 2:SUITE#1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3101
Practice Address - Country:US
Practice Address - Phone:904-940-1577
Practice Address - Fax:904-940-1916
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93245208000000X
NY171237208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8793Medicare UPIN