Provider Demographics
NPI:1215974431
Name:ELMER, JAMES B (MD- RETIRED)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:ELMER
Suffix:
Gender:M
Credentials:MD- RETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-343-3960
Mailing Address - Fax:509-343-0134
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-343-3960
Practice Address - Fax:509-343-0134
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB10702Medicare ID - Type Unspecified