Individual
MR. DAVID GARTH ELLERTSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4101 TULLY RD, SUITE 101, MODESTO, CA 95356-8980
(209) 524-8346
(209) 524-7723
Mailing address
4101 TULLY RD, SUITE 101, MODESTO, CA 95356-8980
(209) 524-8346
(209) 524-7723
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G17987
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20014578
MEDICARE ID
CA
Enumeration date
04/27/2006
Last updated
02/12/2015
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