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General NPI Number Information
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NPI Number | 1306826896
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Entity Type | Individual
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Provider Name | ERIK G ELLSWORTH MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 1501 N GILBERT RD STE 203
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City | GILBERT
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State | AZ
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Zip | 85234-2394
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Country | US
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Telephone | 602-933-3366
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Fax | 602-933-4264
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Provider Business Mailing Address
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Address Line | 3200 E CAMELBACK RD STE 250
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City | PHOENIX
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State | AZ
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Zip | 85018-2327
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Country | US
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Telephone | 602-933-1815
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 41569
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License Number State | AZ
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