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NPI Code Detail

MEDICARE: WILLIAM ELLERT MD

MEDICARE: WILLIAM ELLERT MD
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
1207Q00000XFamily Medicine Physician28129AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861449167
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM ELLERT MD
Provider Business Mailing Address
First Line : FILE 56765
Second Line :
City : LOS ANGELES
State : CA
Zip : 90074-6765
Country : US
Telephone Number : 602-406-3860
Fax Number : 602-406-6132
Provider Business Practice Location Address
First Line : 2927 N 7TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4102
Country : US
Telephone Number : 602-406-3153
Fax Number : 602-406-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 04/27/2012

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Directions to “ WILLIAM ELLERT MD” Practice Location

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