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JERROLD PAUL ELLIOTT PA-C
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1982854618
Individual Registrant: JERROLD PAUL ELLIOTT PA-C
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
16319 THIRD STREET GUERNEVILLE, CA 95446 US
Tel: 707-869-5977 Fax: 707-869-5983
Tel: 707-869-5977 Fax: 707-869-5983
Contact information for business:
PO BOX 1449 GUERNEVILLE, CA 95446-1449 US
Tel: 707-869-5977 Fax: 707-869-5983
Tel: 707-869-5977 Fax: 707-869-5983
Registration Information:
NPI: 1982854618
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CO | 2666 |
| Y | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CA | PA20527 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 1356344758 | CA | 05 |
