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NPI Code Detail

MEDICARE: WILLIAM N ELLEDGE M.D.

MEDICARE:   WILLIAM N ELLEDGE  M.D.
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
1207R00000XInternal Medicine PhysicianMD00012053WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
262142OTHERWAL&I
3T00131OTHERWAREGENCE

General Provider Information

NPI Number : 1851333082
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM N ELLEDGE M.D.
Provider Business Mailing Address
First Line : 111 TUMWATER BLVD SE STE A302
Second Line :
City : TUMWATER
State : WA
Zip : 98501-6400
Country : US
Telephone Number : 360-628-1119
Fax Number :
Provider Business Practice Location Address
First Line : 111 TUMWATER BLVD SE STE A302
Second Line :
City : TUMWATER
State : WA
Zip : 98501-6400
Country : US
Telephone Number : 360-839-2122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 06/19/2024

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Directions to “ WILLIAM N ELLEDGE M.D.” Practice Location

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