Individual
DR. GLEN R. ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., M.D.
Contact information
Practice address
650 CLARK WAY, PALO ALTO, CA 94304-2300
(650) 688-3649
(650) 688-3669
Mailing address
650 CLARK WAY, PALO ALTO, CA 94304-2300
(650) 688-3649
(650) 688-3669
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
G44741
CA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
G44741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G447410
—
CA
Enumeration date
08/17/2006
Last updated
11/10/2010
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