Individual
DR. JOSEPH ROBERT ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12808 AUGUSTA AVE, OMAHA, NE 68144-3733
(402) 330-5690
(402) 330-5689
Mailing address
2725 S 107TH ST, OMAHA, NE 68124-2429
(402) 393-2860
(402) 330-5689
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11477
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47054602612
—
NE
Enumeration date
11/02/2006
Last updated
07/08/2007
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