Provider Demographics
NPI:1669539318
Name:ELMORE, FREDERICK A (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:ELMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7131 N 11TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3375
Mailing Address - Country:US
Mailing Address - Phone:559-435-0717
Mailing Address - Fax:559-435-9105
Practice Address - Street 1:7131 N 11TH ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3375
Practice Address - Country:US
Practice Address - Phone:559-435-0717
Practice Address - Fax:559-435-9105
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C372670208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942588262OtherTAX ID#
CA942588262OtherTAX ID#
CAA36556Medicare UPIN