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NPI Code Detail

MEDICARE: ELLIOT RYAN CARLISLE MD INC

MEDICARE: ELLIOT RYAN CARLISLE MD INC
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
1207XS0117XOrthopaedic Surgery of the Spine PhysicianA74780CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A74780OTHERCASTATE LICENSE
21669453676OTHERCATYPE 1 NPI

General Provider Information

NPI Number : 1427225440
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLIOT RYAN CARLISLE MD INC
Provider Business Mailing Address
First Line : 17525 VENTURA BLVD STE 203
Second Line :
City : ENCINO
State : CA
Zip : 91316-5109
Country : US
Telephone Number : 310-986-0200
Fax Number : 818-986-4390
Provider Business Practice Location Address
First Line : 17525 VENTURA BLVD STE 203
Second Line :
City : ENCINO
State : CA
Zip : 91316-5109
Country : US
Telephone Number : 310-986-0200
Fax Number : 818-986-4390
Authorized Official
Title or Position : OWNER AND SURGEON
Name : DR. ELLIOT RYAN CARLISLE
Credential : MD
Telephone Number : 818-986-0200
Provider Enumeration Date : 05/08/2008
Last Update Date : 05/08/2008

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Directions to “ELLIOT RYAN CARLISLE MD INC ” Practice Location

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