Provider Demographics
NPI:1346690096
Name:ASGHAR, ELISE B (MD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:B
Last Name:ASGHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:M
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:707-521-7799
Mailing Address - Fax:707-573-5431
Practice Address - Street 1:3883 AIRWAY DR STE 165
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1675
Practice Address - Country:US
Practice Address - Phone:707-521-7799
Practice Address - Fax:707-573-5431
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153661207XX0005X
UT12264846-1205207XX0005X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program