Provider Demographics
NPI:1407894611
Name:ELZEY, DELYNN HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:DELYNN
Middle Name:HOWARD
Last Name:ELZEY
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 1:315 E COOK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3311
Mailing Address - Country:US
Mailing Address - Phone:260-458-3800
Mailing Address - Fax:
Practice Address - Street 1:315 E COOK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3311
Practice Address - Country:US
Practice Address - Phone:260-458-3800
Practice Address - Fax:260-458-3803
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025338A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN668030BMedicare PIN
IN668020BMedicare PIN
INE03599Medicare UPIN
IN668040BMedicare PIN
IN090430GMedicare PIN
IN192240EMedicare PIN