Healthcare Provider Details

I. General information

NPI: 1750744140
Provider Name (Legal Business Name): ASHTON CAMERON ELLISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY INTERNAL MEDICINE
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

3434 SWISS AVE STE 200
DALLAS TX
75204-6251
US

V. Phone/Fax

Practice location:
  • Phone: 318-813-2528
  • Fax: 318-813-2528
Mailing address:
  • Phone: 469-800-7050
  • Fax: 469-800-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10061672
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberS6170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: