Johnson, David Ellsworth
Johnson, David Ellsworth is an individual health care provider with primary practice located at 3100 Tongass Ave , Ketchikan AK 99901-5746. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Johnson, David Ellsworth can be contacted via phone (907) 225-4463.Contact Information
Primary practice address
3100 Tongass Ave
Ketchikan AK 99901-5746
Phone: (907) 225-4463
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 1160 | Alaska |
Profile Details
| NPI number | 1396803763 |
|---|---|
| LBN Legal business name | Johnson, David Ellsworth |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 5th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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 | 1396803763 | NPPES |
| Alaska | MEDICAID | MD1213 | |
| Alaska | Other | R004 |
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