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Individual
DR. GARY WAYNE ELAM
Active
Individual
DR. GARY WAYNE ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
10309
OK
207Y00000X
Otolaryngology Physician
Primary
E3259
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R664
BC/BS PROVIDER NUMBER
TX
Enumeration date
07/21/2006
Last updated
07/16/2007
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