MEDICARE: DR. ELISABETH C MCLEMORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	A103714	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649255621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH C MCLEMORE M.D.

Provider Business Mailing Address
First Line	:	MOORES UCSD CANCER CTR
Second Line	:	3855 HEALTH SCIENCES DRIVE
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0001
Country	:	US
Telephone Number	:	858-822-6100
Fax Number	:	866-773-2703

Provider Business Practice Location Address
First Line	:	MOORES UCSD CANCER CTR
Second Line	:	3855 HEALTH SCIENCES DRIVE
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0001
Country	:	US
Telephone Number	:	858-822-6100
Fax Number	:	866-773-2703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/01/2021

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