Provider Demographics
NPI:1710905260
Name:TRULOCK, ELBERT P III (MD)
Entity Type:Individual
Prefix:DR
First Name:ELBERT
Middle Name:P
Last Name:TRULOCK
Suffix:III
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 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8052
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-8917
Mailing Address - Fax:314-454-5571
Practice Address - Street 1:4921 PARKVIEW PL FL 8
Practice Address - Street 2:8TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-454-8917
Practice Address - Fax:314-454-5571
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9649207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO201939907Medicaid
MO172010183Medicaid
IL$$$$$$$$$Medicaid