Provider Demographics
NPI:1184254690
Name:ELROD, JOSHUA BLAKE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BLAKE
Last Name:ELROD
Suffix:
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 1:533 LEE ROAD 57 LOT 170
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-8784
Mailing Address - Country:US
Mailing Address - Phone:256-640-2083
Mailing Address - Fax:
Practice Address - Street 1:533 LEE ROAD 57 LOT 170
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-8784
Practice Address - Country:US
Practice Address - Phone:256-640-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12644390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program