Individual
MRS. MARY JO ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 S CLINTON ST, #195, IOWA CITY, IA 52240-4034
(319) 384-0520
Mailing address
2941 SIERRA CT SW, IOWA CITY, IA 52240-8503
(319) 337-7642
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001965
IA
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MEMBERP00737311
RAILROAD MEDICARE
IA
Enumeration date
11/08/2008
Last updated
09/08/2010
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