MEDICARE: JOHN ALLAN ELLERTON MD, CM

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
1	207RH0003X	Hematology & Oncology Physician	3861	NV
2	207RH0003X	Hematology & Oncology Physician	G39440	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P01062140	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3861	OTHER	NV	LICENSE
3	G39440	OTHER	CA	LICENSE
4	01673965	OTHER	NV	AMERIGROUP
5	0098707	OTHER	NV	CIGNA
7	4297063	OTHER	NV	AETNA

General Provider Information

NPI Number	:	1962585745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ALLAN ELLERTON MD, CM

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-724-8777
Fax Number	:	702-352-2790

Provider Business Practice Location Address
First Line	:	1655 E CACTUS AVE STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7723
Country	:	US
Telephone Number	:	702-724-8777
Fax Number	:	702-352-2790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/17/2025

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Directions to “ JOHN ALLAN ELLERTON MD, CM” Practice Location

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