Individual
DR. JOHN HOLBERT ELLYSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 LOWE ST, JACKSON, CA 95642-2544
(209) 223-2474
Mailing address
340 LOWE ST, JACKSON, CA 95642-2544
(209) 223-2474
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G15379
CA
Other
Enumeration date
02/24/2006
Last updated
07/08/2007
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