Organization
WESTERN ASSOCIATES IN SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ELLERTSON (CARDIOVASCULAR DISEASE)
(209) 526-8038
Entity
Organization
Contact information
Practice address
2209 COFFEE ROAD, SUITE M, MODESTO, CA 95355
(209) 526-8038
Mailing address
2209 COFFEE ROAD, SUITE M, MODESTO, CA 95355
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G17987
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP7941
MEDICARE ID
CA
Enumeration date
05/09/2007
Last updated
03/06/2008
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