Individual
DR. GARY WAYNE ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 N WASHINGTON AVE, ODESSA, TX 79761-4435
(432) 337-4321
Mailing address
520 N WASHINGTON AVE, ODESSA, TX 79761-4435
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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