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General NPI Number Information
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NPI Number | 1205372547
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Entity Type | Individual
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Provider Name | SAMUEL ELZAY
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Gender | Male
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 711 N TAYLOR ST
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City | GUNNISON
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State | CO
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Zip | 81230-2296
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Country | US
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Telephone | 970-641-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 130 E VIRGINIA AVE
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City | GUNNISON
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State | CO
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Zip | 81230-2246
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA0009034
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1502640
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0008934
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License Number State | CO
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