Ellertson, David Garth
Ellertson, David Garth is an sole proprietor health care provider with primary practice located at 4101 Tully Rd Suite 101, Modesto CA 95356-8980. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Ellertson, David Garth can be contacted via phone (209) 524-8346.Contact Information
Primary practice address
4101 Tully Rd Suite 101
Modesto CA 95356-8980
Phone: (209) 524-8346
Fax: (209) 524-7723
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | G17987 | California |
Profile Details
| NPI number | 1912964495 |
|---|---|
| LBN Legal business name | Ellertson, David Garth |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 27th, 2006 |
| Last updated | Feb 12th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912964495 | NPPES |
| California | Other | 20014578 | MEDICARE ID |
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