Provider Demographics
NPI:1467642827
Name:JAMES C ELMER, MD PA
Entity Type:Organization
Organization Name:JAMES C ELMER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-783-2213
Mailing Address - Street 1:699 W COCOA BEACH CSWY STE 501
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3562
Mailing Address - Country:US
Mailing Address - Phone:321-783-2213
Mailing Address - Fax:
Practice Address - Street 1:699 W COCOA BEACH CSWY STE 501
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3562
Practice Address - Country:US
Practice Address - Phone:321-783-2213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0051193207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1516522005OtherCIGNA
FL4108118OtherAETNA
FL04468OtherBCBS
FL1516522002OtherCIGNA
FL1516522005OtherCIGNA
FL1516522005OtherCIGNA
FLK2024Medicare PIN
FL4108118OtherAETNA