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General NPI Number Information
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NPI Number | 1023386596
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Entity Type | Individual
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Provider Name | DAVID GRAY ELMORE MDIV
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Gender | Male
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 505 W. 3RD AVENUE
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City | NOME
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State | AK
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Zip | 99762
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Country | US
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Telephone | 907-443-5259
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Fax | 907-443-2990
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | NOME
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State | AK
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Zip | 99762-0098
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Country | US
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Telephone | 907-443-5259
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Fax | 907-443-2990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | AK
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