Healthcare Provider Details

I. General information

NPI: 1336174085
Provider Name (Legal Business Name): JAMES MICHAEL ELMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16230 SUMMERLIN RD STE 215
FORT MYERS FL
33908-5769
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-7474
  • Fax: 239-343-4190
Mailing address:
  • Phone: 239-343-7474
  • Fax: 239-343-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME180658
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number055002
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: