MR. DAVID GARTH ELLERTSON SR. (NPI# 1912964495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1912964495 |
Entity Type | Individual |
Full Name | MR. DAVID GARTH ELLERTSON SR. |
Credential | M.D. |
Practice Address |
4101 Tully Rd Suite 101 Modesto CA 95356-8980 |
Practice Telephone | 2095248346 |
Practice Fax Number | 2095247723 |
Mailing Telephone | 2095248346 |
Mailing Fax Number | 2095247723 |
Enumeration Date | 2006-04-27 |
Last Update Date | 2015-02-12 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
G17987 | CA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | MEDICARE ID | 20014578 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588657258 | David Garth Ellertson Jr. | Surgery | 2555 Court Dr Ste 450, Gastonia, NC 28054-2191 | 2005-08-26 |
Street Address |
4101 TULLY RD SUITE 101 |
City | MODESTO |
State | CA |
Zip Code | 95356-8980 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376901371 | Nasrin Ergash | Dentist | 4101 Tully Rd, Modesto, CA 95356-8980 | 2016-02-04 |
1083984942 | Wesley E Wong | Dentist | 4101 Tully Rd, Suite 201, Modesto, CA 95356-8980 | 2012-01-10 |
1700983301 | Linda Chen | Dentist | 4101 Tully Rd, Suite 601, Modesto, CA 95356 | 2006-09-19 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649809021 | Amelia E Delgadillo | Licensed Vocational Nurse | 501 Triangle Rd, Modesto, CA 95356 | 2020-04-07 |
1689220279 | Meagan Veneman | Physical Medicine & Rehabilitation | 125 Hogue Rd, Modesto, CA 95356 | 2019-08-10 |
1497131213 | Hermes Guardian Transport | Non-emergency Medical Transport (VAN) | 4221 Erin Way, Modesto, CA 95356 | 2015-08-04 |
1811373640 | Melissa Ruiz | Marriage & Family Therapist | 5815 Stoddard Rd Suite 600, Modesto, CA 95356 | 2015-08-04 |
1922242866 | Lifecare Solutions Inc | Durable Medical Equipment & Medical Supplies | 500 Glass Ln Ste H, Modesto, CA 95356 | 2009-04-22 |
1659541647 | Ashley Allison Streeter | Dentist | 556 Lyell Dr, Modesto, CA 95356 | 2008-03-05 |
1265636013 | Margaret Kathleen Grisell | Orthopaedic Surgery | 4601 Dale Ave, Kaiser Modesto Medical Center, Orthopedic Surgery, Modesto, CA 95356 | 2007-06-14 |
1841412111 | Bobby Gene Boswell | Specialist/Technologist | 3908 Vintage Cove, Modesto, CA 95356 | 2007-05-03 |
1598892861 | Merritt Radiological Medical Group Inc | Radiology | 526 Charity Way, Modesto, CA 95356 | 2007-02-27 |
1396871091 | Michael Steven Beck | Social Worker | 4640 Spyres Way, Building B, Suite 7, Modesto, CA 95356 | 2007-02-26 |
Find all providers in zip 95356 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316987373 | Hugh Mcnair Tobin | Surgery | 1406 River Oaks Dr, Modesto, CA 95356-8869 | 2006-06-07 |
1366499584 | James C Macmillan | Surgery | 1541 Florida Ave, 103, Modesto, CA 95350-4423 | 2006-05-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881213817 | Robert Morton Carroll X | Surgery | 2241 Century Hl, Los Angeles, CA 90067-3506 | 2020-04-09 |
1992341895 | Surgicalist of Ca PC | Surgery | 3300 E South St Ste 301a, Lakewood, CA 90805-4549 | 2019-11-26 |
1528600558 | Kevin M Casey Md Apmc | Surgery | 1919 State St # 204-206, Santa Barbara, CA 93101-2430 | 2019-10-10 |
1487117594 | John Nastasi | Surgery | 100 W Valencia Mesa Dr # 211, Fullerton, CA 92835-3768 | 2019-04-08 |
1225508385 | Jay Labourene | Surgery | 1550 G Tiburon Blvd, Tiburon, CA 94920-2531 | 2018-12-03 |
1467922120 | Paul Bressman Md Inc | Surgery | 1493 S Crest Dr, Los Angeles, CA 90035-3339 | 2018-11-26 |
1437638517 | Thousand Oaks Vein Clinic PC | Surgery | 225 N Moorpark Rd Ste C, Thousand Oaks, CA 91360-4320 | 2018-08-09 |
1881186377 | Lavs Access Center Inc. | Surgery | 620 W Beverly Blvd Ste B, Montebello, CA 90640-3624 | 2018-05-31 |
1841789328 | Sunil Rayan, M.d., Inc. | Surgery | 320 Santa Fe Dr Ste 212, Encinitas, CA 92024-5139 | 2018-05-09 |
1245739820 | Northridge Vascular Center A Professional Medical Corporation | Surgery | 19331 Business Center Dr Ste 102, Northridge, CA 91324-3533 | 2018-02-08 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.