David Garth Ellertson in Modesto - Vascular Surgery
David Garth Ellertson - NPI 1912964495
David Garth Ellertson is a Vascular Surgery in Modesto, California. David Garth Ellertson practices all healthcare services and medical treatments related to Vascular Surgery. The NPI Number for David Garth Ellertson is 1912964495. The last update date is 2015-02-12.
David Garth Ellertson's current location address is 4101 Tully Rd, Modesto, California. You can contact this provider via phone number 2095248346 and fax number 2095247723. The mailing address for David Garth Ellertson is 4101 Tully Rd, Modesto, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | David Garth Ellertson |
|---|---|
| Address | 4101 Tully Rd, Modesto, California |
| Phone Number | 2095248346 |
| Fax Number | 2095247723 |
| Sole Proprietor | Y |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1912964495 |
|---|---|
| Provider Enumeration Date | 2006-04-27 |
| Last Updated Date | 2015-02-12 |
Provider Mailing Address Detail
| Address | 4101 Tully Rd |
|---|---|
| City | Modesto |
| State | California (CA) |
| Post Code | 953568980 |
| Phone Number | 2095248346 |
| Fax Number | 2095247723 |
Provider's Primary Taxonomy Detail
| Speciality | Vascular Surgery |
|---|---|
| Taxonomy | 2086S0129X |
| Licence No | G17987 |
|
Definition: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 20014578 | CA | MEDICARE ID |
Post Comment/ Review Below
What is the David Garth Ellertson's unique identification number?
The David Garth Ellertson has been assigned the NPI (National Provider Identifier) Number 1912964495 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you kindly provide the complete physical address where David Garth Ellertson's facilities are geographically located?
The facilities of David Garth Ellertson are physically situated at the following location: 4101 Tully Rd, Modesto, CA, 953568980.
What is David Garth Ellertson's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for David Garth Ellertson is Vascular Surgery, and the taxonomy code that categorizes this field of expertise is 2086S0129X.
On what date did David Garth Ellertson receive its 1912964495 assignment from the Centers for Medicare & Medicaid Services?
The David Garth Ellertson was assigned its 1912964495 on 2006-04-27, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details related to David Garth Ellertson most recently updated or revised?
The information pertaining to David Garth Ellertson, including its address, specialty, and other relevant details, was last updated or revised on 2015-02-12.
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