MEDICARE: DR. ELIZABETH BLAIR BIAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 16873	CA

General Provider Information

NPI Number	:	1114083623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH BLAIR BIAS

Provider Business Mailing Address
First Line	:	410 HAMPTON CT
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-2526
Country	:	US
Telephone Number	:	925-275-2797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 CROW CANYON RD
Second Line	:	SUITE 219 A
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1655
Country	:	US
Telephone Number	:	925-275-2797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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