MR. DAVID GARTH ELLERTSON SR.


Address: 4101 Tully Rd, Suite 101, Modesto, CA 95356-8980
Phone: 2095248346

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2086S0129X Surgery
Specialization: Vascular Surgery
G17987 CA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA MEDICARE ID 20014578 01

Other Providers DAVID ELLERTSON

NPI Name Taxonomy Address Enumeration
1588657258 David Garth Ellertson Jr. Surgery 2555 Court Dr Ste 450, Gastonia, NC 28054-2191 2005-08-26

Office Location

Street Address 4101 TULLY RD
SUITE 101
City MODESTO
State CA
Zip Code 95356-8980

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 2086S0129X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery
Specialization Vascular Surgery

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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Competitor

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City MODESTO
Zip Code 95356

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Dataset Information

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.

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