Provider Demographics
NPI:1821159187
Name:ELKINS, DAVID A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ELKINS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0927
Mailing Address - Country:US
Mailing Address - Phone:928-681-8686
Mailing Address - Fax:928-681-8690
Practice Address - Street 1:2973 12TH STREET SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6162
Practice Address - Country:US
Practice Address - Phone:503-561-7100
Practice Address - Fax:503-561-7124
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24434208800000X
NMMD2021-0337208800000X
AZ29019208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227295Medicaid
ORG82980Medicare UPIN
OR227295Medicaid