| Richard T Elmore Jr Phd Pa | |
|
100 Rialto Pl Suite 754 Melbourne FL 32901-3055 | |
| (321) 728-9620 | |
| (321) 951-1928 |
| Full Name | Richard T Elmore Jr Phd Pa |
|---|---|
| Speciality | Psychologist |
| Location | 100 Rialto Pl, Melbourne, Florida |
| Authorized Official Name and Position | Richard Turner Elmore (PROPRIETOR) |
| Authorized Official Contact | 3217289620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard T Elmore Jr Phd Pa 100 Rialto Pl Suite 754 Melbourne FL 32901-3055 Ph: (321) 728-9620 | Richard T Elmore Jr Phd Pa 100 Rialto Pl Suite 754 Melbourne FL 32901-3055 Ph: (321) 728-9620 |
| NPI Number | 1700116274 |
|---|---|
| Provider Enumeration Date | 01/06/2010 |
| Last Update Date | 01/28/2014 |
| Medicare PECOS PAC ID | 8729120977 |
|---|---|
| Medicare Enrollment ID | O20100126000539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700116274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY3228 (Florida) | Primary |
| Provider Name | Richard T Elmore |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740214766 PECOS PAC ID: 5193867349 Enrollment ID: I20100126000520 |
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