JOHN ELLOWAY MD A PROFESSIONAL CORP NPI 1174794770

NPI Information

JOHN ELLOWAY MD A PROFESSIONAL CORP is a primary care clinic center in Novato, CA. JOHN ELLOWAY MD A PROFESSIONAL CORP NPI is 1174794770. The provider is registered as an organization entity type.
The provider Is Doing Business As N/a.

The provider's business location address is:

1324 GRANT AVE
NOVATO, CA
ZIP 94945-152
Phone: (415) 892-3300
Fax: (415) 897-0079

The provider's authorized official is John Elloway .
The authorized official title is Director and has the following contact phone number (415) 892-3300.

The CLIA number assigned to this NPI record is 05D1068414 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/21/2008 and was last updated on 11/15/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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