Provider Demographics
NPI:1023091477
Name:ELKAYAM, EZRA SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:EZRA
Middle Name:SAMUEL
Last Name:ELKAYAM
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 1:2311 N MESA ST STE F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3575
Mailing Address - Country:US
Mailing Address - Phone:915-544-6400
Mailing Address - Fax:915-544-2836
Practice Address - Street 1:2311 N MESA ST STE F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3575
Practice Address - Country:US
Practice Address - Phone:915-544-6400
Practice Address - Fax:915-544-2836
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ10832084N0400X
FLME888902084N0400X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1541966Medicaid
FL269879000Medicaid
MS09737392Medicaid
FL269879000Medicaid
MS09737392Medicaid
LA410420YH3VMedicare PIN
LA410420YH3UMedicare PIN