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NPI Code Detail

MEDICARE: JUSTIN EBERT P.A.

MEDICARE: JUSTIN EBERT P.A.
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
1363AM0700XMedical Physician AssistantPA17809CA

General Provider Information

NPI Number : 1942379391
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN EBERT P.A.
Provider Business Mailing Address
First Line : 333 LAWS AVE
Second Line :
City : UKIAH
State : CA
Zip : 95482-6540
Country : US
Telephone Number : 707-468-1010
Fax Number : 707-468-0174
Provider Business Practice Location Address
First Line : 333 LAWS AVE
Second Line :
City : UKIAH
State : CA
Zip : 95482-6540
Country : US
Telephone Number : 707-468-1010
Fax Number : 707-468-0174
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 07/08/2007

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Directions to “ JUSTIN EBERT P.A.” Practice Location

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