Healthcare Provider Details

I. General information

NPI: 1164441663
Provider Name (Legal Business Name): ELIZABETH ANTHONY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 APPIAN WAY SUITE 200
PINOLE CA
94564-2576
US

IV. Provider business mailing address

2160 APPIAN WAY SUITE 200
PINOLE CA
94564-2576
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-9110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC34387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: