Individual provider · NPI-1

Dr. Richard Ashley Ellis, D.O.

Family Medicine, Sports Medicine · Redwood City, CA

NPI number1386702140
StatusActive
Last updated in NPPESMar 7, 2023

Details

NPI
1386702140
Entity type
Individual (NPI-1)
Name
Dr. Richard Ashley Ellis
Credential
D.O.
Sex
Male
Sole proprietor
Yes
Enumeration date
Dec 5, 2006
Certification date
Sep 6, 2022
Last updated
Mar 7, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207QS0010X Family Medicine, Sports Medicine12689CAYes
207Q00000X Family MedicineOS17840FL

Practice location

1190 Veterans Blvd Ste C
Redwood City, CA 94063-2037

Phone 650-299-7800

Mailing address

12234 Panama City Beach Pkwy Ste B
Panama City Beach, FL 32407-2726

Phone 850-233-2323 · Fax 850-233-1055

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