Individual
DR. ELIZABETH ANN HEREFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
999 S FAIRMONT AVE STE 220, LODI, CA 95240-5142
(209) 334-9462
(209) 334-9470
Mailing address
27901 BRUELLA RD, GALT, CA 95632-8245
(209) 369-9462
(209) 334-9470
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
00G53434
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G53434
MEDICARE
CA
01
—
A52522
UPIN
CA
Enumeration date
02/23/2007
Last updated
07/08/2007
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