Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO163 | HI |
NPI | 1205844685 |
---|---|
Provider Name | Dr. Richard J. Elliston |
First Address | Fort Riley, KS 66442-5037 |
Second Address | Fort Riley, KS 66442-5037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |