MEDICARE: DR. LEE BOSTICK ELAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	R9947	TX

General Provider Information

NPI Number	:	1427411552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE BOSTICK ELAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	800-994-0371
Fax Number	:	254-215-9722

Provider Business Practice Location Address
First Line	:	425 UNIVERSITY BLVD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1360
Country	:	US
Telephone Number	:	512-509-0200
Fax Number	:	512-509-0285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	10/06/2025

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