Healthcare Provider Details

I. General information

NPI: 1487603627
Provider Name (Legal Business Name): ELAN MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 S MCCLINTOCK DR SUITE 201
TEMPE AZ
85283-3392
US

IV. Provider business mailing address

6301 S MCCLINTOCK DR SUITE 201
TEMPE AZ
85283-3392
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-3100
  • Fax: 480-838-3902
Mailing address:
  • Phone: 480-838-3100
  • Fax: 480-838-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23609
License Number StateAZ

VIII. Authorized Official

Name: DR. ROBERT J BLOOMBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 480-838-3100