Healthcare Provider Details

I. General information

NPI: 1821042292
Provider Name (Legal Business Name): JOHN CRAIG ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CIVIC CENTER DR STE 206
SAN RAFAEL CA
94903-5233
US

IV. Provider business mailing address

4000 CIVIC CENTER DR STE 206
SAN RAFAEL CA
94903-5233
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-8070
  • Fax: 415-461-1305
Mailing address:
  • Phone: 415-925-8070
  • Fax: 415-461-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA85668
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25631
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85668
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25631
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: