Provider Demographics
NPI:1245280460
Name:ELMES, CORNELIS MILLARD (MD)
Entity type:Individual
Prefix:
First Name:CORNELIS
Middle Name:MILLARD
Last Name:ELMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 B GALE WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3552
Mailing Address - Country:US
Mailing Address - Phone:707-646-5611
Mailing Address - Fax:707-646-4902
Practice Address - Street 1:2500 HILBORN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1097
Practice Address - Country:US
Practice Address - Phone:707-646-5599
Practice Address - Fax:707-646-5571
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41021207XX0801X
CAA86984207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94494Medicare UPIN