Individual
DR. DAVID ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 TROUSDALE DR, 3RD FLOOR, BURLINGAME, CA 94010-4506
(650) 652-8580
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(650) 652-8580
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G46178
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ80557Z
BLUE SHIELD
CA
05
—
ZZZ80557Z
—
CA
Enumeration date
07/20/2006
Last updated
06/19/2020
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