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General NPI Number Information
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NPI Number | 1174794770
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Entity Type | Organization
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Legal Business Name | JOHN ELLOWAY MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 1324 GRANT AVE
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City | NOVATO
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State | CA
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Zip | 94945-3152
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Country | US
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Telephone | 415-892-3300
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Fax | 415-897-0079
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Provider Business Mailing Address
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Address Line | 1324 GRANT AVE
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City | NOVATO
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State | CA
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Zip | 94945-3152
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Country | US
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Telephone | 415-892-3300
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Fax | 415-897-0079
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN ELLOWAY
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Credential | M.D.
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Telephone | 415-892-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ZZZ24941Z
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License Number State | CA
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