Healthcare Provider Details

I. General information

NPI: 1386855823
Provider Name (Legal Business Name): PATRICIA ELVIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W TOWN PL SUITE#1
ST AUGUSTINE FL
32092-3101
US

IV. Provider business mailing address

319 W TOWN PL SUITE#1
ST AUGUSTINE FL
32092-3101
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-1577
  • Fax: 904-940-1916
Mailing address:
  • Phone: 904-940-1577
  • Fax: 904-940-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME93245
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number171237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: