MEDICARE: EVAN MCELROY DMD

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	1223G0001X	General Practice Dentistry	DN28036	FL

General Provider Information

NPI Number	:	1952171258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN MCELROY DMD

Provider Business Mailing Address
First Line	:	15430 KILBIRNIE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-2423
Country	:	US
Telephone Number	:	239-281-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3416
Country	:	US
Telephone Number	:	239-334-6136
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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