Individual
DR. RICHARD T ELMORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
100 RIALTO PL, SUITE 754, MELBOURNE, FL 32901-3055
(321) 728-9620
(321) 951-1928
Mailing address
100 RIALTO PL, SUITE 754, MELBOURNE, FL 32901-3055
(321) 728-9620
(321) 951-1928
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY3228
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
592345361
TRICARE PROVIDER #
FL
01
—
75204
BCBS PROVIDER NUMBER
FL
Enumeration date
07/10/2006
Last updated
01/06/2010
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