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General NPI Number Information
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NPI Number | 1952445058
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Entity Type | Individual
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Provider Name | JEFFREY MARK ELROD M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 200 E CHESTNUT ST STE 303
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City | LOUISVILLE
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State | KY
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Zip | 40202-1831
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Country | US
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Telephone | 502-629-5552
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Fax | 602-629-3132
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Provider Business Mailing Address
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Address Line | PO BOX 950202
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City | LOUISVILLE
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State | KY
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Zip | 40295-0202
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Country | US
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Telephone | 502-969-6552
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Fax | 502-969-3799
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R1105
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 42545
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License Number State | KY
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