Individual
MR. BRUCE ELLARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
317 KNUTSON DR, MADISON, WI 53704-1133
(608) 301-9337
(608) 301-9388
Mailing address
317 KNUTSON DR, MADISON, WI 53704-1133
(608) 301-9337
(608) 301-9388
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41667500
—
WI
Enumeration date
11/01/2006
Last updated
07/09/2007
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