Provider Demographics
NPI:1871737130
Name:DELEON, ELMA TIROL (MD)
Entity type:Individual
Prefix:
First Name:ELMA
Middle Name:TIROL
Last Name:DELEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 WRIGLEY DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5286
Mailing Address - Country:US
Mailing Address - Phone:509-545-6220
Mailing Address - Fax:509-545-6842
Practice Address - Street 1:7425 WRIGLEY DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5286
Practice Address - Country:US
Practice Address - Phone:509-545-6220
Practice Address - Fax:509-545-6842
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017909207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8547697Medicaid
WA501337Medicare Oscar/Certification