Individual
MR. ARTHUR ELLSWORTH ELLISON V
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, GH219, PORTLAND, OR 97239-3011
(503) 494-3633
Mailing address
3181 SW SAM JACKSON PARK RD, GH219, PORTLAND, OR 97239-3011
(503) 494-3633
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA179882
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/03/2015
Last updated
11/02/2016
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