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General NPI Number Information
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NPI Number | 1700316403
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Entity Type | Individual
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Provider Name | BRIAN ALLEN ELLISON MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 8670 WILSHIRE BLVD STE 101
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2930
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Country | US
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Telephone | 310-358-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 S LA CIENEGA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90016-4316
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 281766
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A183776
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License Number State | CA
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