Provider Demographics
NPI:1497340426
Name:MCELHANEY, TIMOTHY RAY
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:MCELHANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEC
Other - Middle Name:
Other - Last Name:MCELHANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:325 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2647
Mailing Address - Country:US
Mailing Address - Phone:907-865-7501
Mailing Address - Fax:
Practice Address - Street 1:325 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2647
Practice Address - Country:US
Practice Address - Phone:907-865-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5890375920302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization