Individual
DR. RICHARD ASHLEY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1190 VETERANS BLVD STE C, REDWOOD CITY, CA 94063-2037
(650) 299-7800
Mailing address
12234 PANAMA CITY BEACH PKWY STE B, PANAMA CITY BEACH, FL 32407-2726
(850) 233-2323
(850) 233-1055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS17840
FL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
12689
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12689
CA MEDICAL LICENSE
CA
Enumeration date
12/05/2006
Last updated
03/07/2023
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