Organization
EAR NOSE AND THROAT MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID ELLISON M.D. (M.D.)
(650) 344-6896
Entity
Organization
Contact information
Practice address
805 VETERANS BLVD STE 115, REDWOOD CITY, CA 94063-1755
(650) 369-1619
Mailing address
100 S ELLSWORTH AVE STE 308, SAN MATEO, CA 94401-3931
(650) 344-6896
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ80557Z
—
CA
Enumeration date
04/20/2007
Last updated
08/22/2020
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