Individual
ALLAN J. ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 598-5618
(206) 598-5720
Mailing address
PO BOX 24366, SEATTLE, WA 98124-0366
(206) 598-0502
(206) 598-0516
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10004406
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170439
LABOR & INDUSTRY
WA
01
—
55843U
REGENCE BLUESHIELD
WA
05
—
8356339
—
WA
Enumeration date
07/21/2006
Last updated
10/11/2007
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