Healthcare Provider Details

I. General information

NPI: 1790914323
Provider Name (Legal Business Name): JEFFREY CHARLES ELMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 5TH AVE STE 400
SPOKANE WA
99204-4880
US

IV. Provider business mailing address

104 W 5TH AVE STE 400
SPOKANE WA
99204-4880
US

V. Phone/Fax

Practice location:
  • Phone: 509-353-3960
  • Fax: 509-343-0134
Mailing address:
  • Phone: 509-353-3960
  • Fax: 509-343-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD00024826
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD000248226
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD00024826
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: