=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770770240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EZRA S ELKAYAM MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2007
-----------------------------------------------------
Last Update Date | 05/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 MEASE DR SUITE 315
-----------------------------------------------------
City | SAFETY HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-793-0663
-----------------------------------------------------
Fax | 727-793-0664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1840 MEASE DR SUITE 315
-----------------------------------------------------
City | SAFETY HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-793-0663
-----------------------------------------------------
Fax | 727-793-0664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. EZRA S ELKAYAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 727-793-0663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------