1912066739 NPI number — DR. ELISABETH PROSSER BELLOWS M.D.

Table of content: DR. ELISABETH PROSSER BELLOWS M.D. (NPI 1912066739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912066739 NPI number — DR. ELISABETH PROSSER BELLOWS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLOWS
Provider First Name:
ELISABETH
Provider Middle Name:
PROSSER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912066739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
617 VETERANS BLVD.
Provider Second Line Business Mailing Address:
SUITE #107
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-306-8909
Provider Business Mailing Address Fax Number:
650-306-8910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617 VETERANS BLVD.
Provider Second Line Business Practice Location Address:
SUITE #107
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-306-8909
Provider Business Practice Location Address Fax Number:
650-306-8910
Provider Enumeration Date:
12/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  G50067 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G50067 . This is a "LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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