Individual
GREGORY LEE ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2127 E BASELINE RD STE 104, TEMPE, AZ 85283-1537
(480) 897-7070
(480) 897-2597
Mailing address
2127 E BASELINE RD STE 104, TEMPE, AZ 85283-1537
(480) 897-7070
(480) 897-2597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD12426
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080055004
RAILROAD MEDICARE
AZ
05
—
214510
—
AZ
01
—
AZ0006680
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/04/2006
Last updated
05/21/2008
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