Provider Demographics
NPI:1275639486
Name:LAVEY, ELLIOTT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:B
Last Name:LAVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 288
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4031
Mailing Address - Country:US
Mailing Address - Phone:925-820-3633
Mailing Address - Fax:925-820-3655
Practice Address - Street 1:913 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 288
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4031
Practice Address - Country:US
Practice Address - Phone:925-820-3633
Practice Address - Fax:925-820-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist