Provider Demographics
NPI:1649232513
Name:ELMORE, DALE BRYANT (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:BRYANT
Last Name:ELMORE
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 1:417 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5807
Mailing Address - Country:US
Mailing Address - Phone:865-982-0886
Mailing Address - Fax:865-982-0841
Practice Address - Street 1:417 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5807
Practice Address - Country:US
Practice Address - Phone:865-982-0886
Practice Address - Fax:865-982-0841
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD014177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3196721Medicare ID - Type Unspecified
B04721Medicare UPIN