Provider Demographics
NPI:1790892529
Name:ELGIN, DONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:ELGIN
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:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1008
Mailing Address - Country:US
Mailing Address - Phone:918-478-2101
Mailing Address - Fax:918-478-6008
Practice Address - Street 1:104 LONE OAK CIRCLE
Practice Address - Street 2:
Practice Address - City:FT. GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434
Practice Address - Country:US
Practice Address - Phone:918-478-2101
Practice Address - Fax:918-478-6008
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11727207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123270AMedicaid
OK107709001OtherDMERC
OK80161083OtherRR MEDICARE
OKOK403702Medicare PIN
OK100123270AMedicaid
OK$$$$$$$$$KMedicare PIN