Basic Information
| Provider Information | |||||||||
| NPI: | 1649255621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLEMORE | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MOORES UCSD CANCER CTR | ||||||||
| Address2: | 3855 HEALTH SCIENCES DRIVE | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588226100 | ||||||||
| FaxNumber: | 8667732703 | ||||||||
| Practice Location | |||||||||
| Address1: | MOORES UCSD CANCER CTR | ||||||||
| Address2: | 3855 HEALTH SCIENCES DRIVE | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588226100 | ||||||||
| FaxNumber: | 8667732703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | A103714 | CA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 811126 | 05 | AZ | MEDICAID |