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JERROLD PAUL ELLIOTT PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1982854618

Individual Registrant:
 JERROLD PAUL ELLIOTT PA-C
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

Contact information for business:
PO BOX 1449  GUERNEVILLE, CA 95446-1449 US
Tel: 707-869-5977  Fax: 707-869-5983

Registration Information:
NPI: 1982854618
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
CO2666
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
CAPA20527

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1356344758CA05




HEALTH CARE JOBS CA - Page 1



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