Provider Demographics
NPI:1013770049
Name:ELMORE, ALBERT R JR
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:R
Last Name:ELMORE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E SHERIDAN AVE APT 2448
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-6741
Mailing Address - Country:US
Mailing Address - Phone:405-803-2659
Mailing Address - Fax:
Practice Address - Street 1:505 E SHERIDAN AVE APT 2448
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-6741
Practice Address - Country:US
Practice Address - Phone:405-803-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist