Warren L Ellison, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00023004 Issued in WA

Legal business name

WARREN L ELLISON, M.D.

Practice address

1207 Evergreen CT
Clarkston, WA 99403-2843

Phone

(208) 758-2928

Fax

(208) 758-2623

NPI assigned

Jul 17, 2007

Last updated

Apr 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeff J Bishop

Title

Account Manager

Phone

(208) 683-2928

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Warren L Ellison, M.D.

  • Family Medicine Physician
  • Clarkston, WA
  • NPI 1982718235
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1619176799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 EVERGREEN CT",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032843",
            "telephone_number": "208-758-2928",
            "fax_number": "208-758-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 EVERGREEN CT",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032843",
            "telephone_number": "208-758-2928",
            "fax_number": "208-758-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN L ELLISON, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "208-683-2928",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00023004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007293",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.