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NPI Code Detail

MEDICARE: SAMMY T ELMOR DO

MEDICARE: SAMMY T ELMOR DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramCA
2208D00000XGeneral Practice Physician1760147805CA

General Provider Information

NPI Number : 1760147805
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMMY T ELMOR DO
Provider Business Mailing Address
First Line : 2500 ALHAMBRA AVE
Second Line :
City : MARTINEZ
State : CA
Zip : 94553-3156
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 ALHAMBRA AVE
Second Line :
City : MARTINEZ
State : CA
Zip : 94553-3156
Country : US
Telephone Number : 925-370-5117
Fax Number : 925-370-5052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2021
Last Update Date : 06/11/2026

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