Individual
WILLIAM N ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 TUMWATER BLVD SE STE A302, TUMWATER, WA 98501-6400
(360) 839-2122
Mailing address
111 TUMWATER BLVD SE STE A302, TUMWATER, WA 98501-6400
(360) 628-1119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00012053
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517200
—
WA
01
—
62142
L&I
WA
01
—
T00131
REGENCE
WA
Enumeration date
06/12/2006
Last updated
06/19/2024
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