Healthcare Provider Details

I. General information

NPI: 1376618389
Provider Name (Legal Business Name): HARRY DONEL ELSHIRE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34730 BOB WILSON DR # 400
SAN DIEGO CA
92134-3098
US

IV. Provider business mailing address

34730 BOB WILSON DR # 400
SAN DIEGO CA
92134-3098
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7577
  • Fax: 619-532-7577
Mailing address:
  • Phone: 619-532-7180
  • Fax: 619-532-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40737
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA40737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: