Individual
DR. BRUCE E ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2940 WHIPPLE AVE, SUITE E, REDWOOD CITY, CA 94062-2857
(650) 366-4585
(650) 366-3896
Mailing address
2940 WHIPPLE AVE, SUITE E, REDWOOD CITY, CA 94062-2857
(650) 366-4585
(650) 366-3896
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A84392
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A843920
BLUE SHIELD PROVIDER ID #
CA
Enumeration date
07/11/2006
Last updated
07/09/2007
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