Individual
DR. SAMUEL FRED ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 UNION ST, SUITE 520, SAN FRANCISCO, CA 94123-4114
(415) 922-3344
(415) 921-7759
Mailing address
2001 UNION ST, SUITE 520, SAN FRANCISCO, CA 94123-4114
(415) 922-3344
(415) 921-7759
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A41459
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ28290Z
MEDICARE GROUP
CA
Enumeration date
11/02/2006
Last updated
03/11/2024
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