Provider Demographics
NPI:1891927182
Name:ELEFAN, DARRYL (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:
Last Name:ELEFAN
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 1:6490 MOUNT MORIAH ROAD EXT STE 200
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-3841
Mailing Address - Country:US
Mailing Address - Phone:901-565-0244
Mailing Address - Fax:901-565-0616
Practice Address - Street 1:6490 MOUNT MORIAH ROAD EXT STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-3841
Practice Address - Country:US
Practice Address - Phone:304-720-5000
Practice Address - Fax:304-720-5003
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57163207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV25668OtherSTATE LICENSE
WV3810027323Medicaid
WVFE4427553OtherDEA REGISTRATION NUMBER
WV25668OtherSTATE LICENSE