Provider Demographics
NPI:1871522953
Name:ELAM, GARRETT NMI (DO)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:NMI
Last Name:ELAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1703 N BUERKLE ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-3153
Mailing Address - Country:US
Mailing Address - Phone:870-673-3511
Mailing Address - Fax:870-672-6869
Practice Address - Street 1:1703 N BUERKLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3153
Practice Address - Country:US
Practice Address - Phone:870-673-3511
Practice Address - Fax:870-672-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36545207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR3929OtherLIC
AR115525003Medicaid
ARD41560Medicare UPIN