Provider Demographics
NPI:1427310457
Name:LIFF, ELLIOT (MD)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:LIFF
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 1:40 UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1437
Mailing Address - Country:US
Mailing Address - Phone:415-383-5793
Mailing Address - Fax:
Practice Address - Street 1:40 UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1437
Practice Address - Country:US
Practice Address - Phone:415-383-5793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0017801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC0017801OtherCALIFORNIA STATE LICENSE
CABL7619349OtherBNDD