Provider Demographics
NPI:1679646731
Name:ELAM, ERIK A (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:A
Last Name:ELAM
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 1:4647 ZION AVE
Mailing Address - Street 2:SAN DIEGO KAISER MEDICAL CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:619-528-5000
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2507
Practice Address - Country:US
Practice Address - Phone:619-528-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG713752085R0202X
WAMD000366232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA122263OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WAEL7599OtherREGENCE BLUE SHIELD TRA
WAAB37887OtherMEDICARE PIN ADVANCED OPEN IMAGING
WA300095701OtherRR MEDICARE UNION AVENUE OPEN
WA8226326Medicaid
WAEL7252OtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WAAB05260Medicare ID - Type UnspecifiedTACOMA RADIOLOGICAL ASSOC
WA1940ELOtherREGENCE BLUE SHIELD ADVANCED OPEN IMAGING
WA300095702OtherRR MEDICARE TRA
WA122265OtherLABOR AND INDUSTRIES/WC TRA
WA170314OtherLABOR AND INDUSTRIES/WC ADVANCED OPEN IMAGING
WAAB05262OtherMEDICARE PIN TRA KING COUNTY
WAF01638Medicare UPIN
WAAB05259Medicare ID - Type UnspecifiedUNION AVENUE OPEN MRI