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NPI Code Detail

MEDICARE: DR. RUSSELL MURRAY ELLYSON DO

MEDICARE: DR. RUSSELL MURRAY ELLYSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician20A25336CA

General Provider Information

NPI Number : 1417650052
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL MURRAY ELLYSON DO
Provider Business Mailing Address
First Line : 6060 JOHNSTON DR
Second Line :
City : OAKLAND
State : CA
Zip : 94611-3143
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1411 E 31ST ST
Second Line :
City : OAKLAND
State : CA
Zip : 94602-1092
Country : US
Telephone Number : 510-437-4141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 06/09/2026

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