Provider Demographics
NPI:1568468478
Name:MCELROY, GUY BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:BRUCE
Last Name:MCELROY
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0088
Mailing Address - Country:US
Mailing Address - Phone:541-923-0119
Mailing Address - Fax:541-923-3228
Practice Address - Street 1:645 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1502
Practice Address - Country:US
Practice Address - Phone:541-923-0119
Practice Address - Fax:541-923-3228
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62445Medicare UPIN
101878Medicare ID - Type Unspecified