Individual
DR. JIM R ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3231 S NATIONAL AVE, SUITE 170, SPRINGFIELD, MO 65807-7304
(417) 885-0830
(417) 888-6766
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
108224
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117851
MO BLUE SHIELD
MO
05
—
208880633
—
MO
01
—
99043
ARK BLUE SHIELD
AR
Enumeration date
02/07/2007
Last updated
05/03/2013
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