Healthcare Provider Details

I. General information

NPI: 1891292025
Provider Name (Legal Business Name): ALBERT J. ELUMN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 ALLEGRA WAY
LUTZ FL
33559-6998
US

IV. Provider business mailing address

3571 FAR WEST BLVD UNIT 3124
AUSTIN TX
78731-3064
US

V. Phone/Fax

Practice location:
  • Phone: 813-934-2953
  • Fax:
Mailing address:
  • Phone: 832-212-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12256628-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS5889
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME163300
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberS5889
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: