Provider Demographics
NPI:1639158082
Name:ELBAOR, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:ELBAOR
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 1:3225 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2006
Mailing Address - Country:US
Mailing Address - Phone:817-467-7113
Mailing Address - Fax:817-467-7877
Practice Address - Street 1:3225 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2006
Practice Address - Country:US
Practice Address - Phone:817-467-7113
Practice Address - Fax:817-467-7877
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist