Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G46178 | CA |
NPI | 1033139076 |
---|---|
Provider Name | Dr. David Ellison |
First Address | Los Altos, CA 94022-1408 |
Second Address | Burlingame, CA 94010-4506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50314 | (02) | CA |
ZZZ80557Z | (05) | CA |
ZZZ80557Z | BLUE SHIELD (01) | CA |