Provider Demographics
NPI:1740230903
Name:ELMER, WAYNE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ALAN
Last Name:ELMER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:920 E 1ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-249-7970
Mailing Address - Fax:218-249-7997
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-249-7970
Practice Address - Fax:218-249-7997
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-02-02
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Provider Licenses
StateLicense IDTaxonomies
MN45968207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN490642000Medicaid
MN490642000Medicaid