Provider Demographics
NPI:1104828466
Name:MCELROY, LUISA MARIA GOMEZ (MD)
Entity type:Individual
Prefix:MS
First Name:LUISA
Middle Name:MARIA GOMEZ
Last Name:MCELROY
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 1:10860 SHELDON ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:813-792-1905
Mailing Address - Fax:813-926-1502
Practice Address - Street 1:10860 SHELDON ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:813-792-1905
Practice Address - Fax:813-926-1502
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76549208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255208600Medicaid
FL255208600Medicaid
FL44894ZMedicare PIN