Provider Demographics
NPI:1952445058
Name:ELROD, JEFFREY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:ELROD
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:602-629-3132
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1105207R00000X
KY42545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200967660Medicaid
KY000026447TOtherHUMANA - NIS
KY50024311OtherPASSPORT - NIS
KY6615945OtherCIGNA - NIS
KY000000620784OtherANTHEM - NIS
KY105793OtherSIHO - NIS
KY00533139OtherMEDICARE - NIS
KY7100073850OtherMEDICAID KY (NIS)
KYP00745275OtherRAILROAD MCR KY - NIS
KY3721116000OtherPASSPORT ADVTG - NIS
KYK113790Medicare PIN