Healthcare Provider Details

I. General information

NPI: 1730272378
Provider Name (Legal Business Name): RONALD LEE ELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST. SUITE 512
BERKELEY CA
94705-9470
US

IV. Provider business mailing address

2999 REGENT ST. SUITE 512
BERKELEY CA
94705-9470
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-0734
  • Fax: 510-549-0751
Mailing address:
  • Phone: 510-549-0734
  • Fax: 510-549-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG030542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: