Healthcare Provider Details

I. General information

NPI: 1730406901
Provider Name (Legal Business Name): DAVID ELLIS DISBROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N THESTA ST STE 202
FRESNO CA
93710-5294
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 559-440-0283
  • Fax:
Mailing address:
  • Phone: 864-797-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number32837
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA148973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: