Active NPI
Dale Allan Elleson, DO
- Otolaryngology Physician
- Fremont, CA
National Provider Identifier
1740226000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 20A4511
- Practice address
- 2557 Mowry Ave
#30
Fremont, CA 94538 - Phone
- (510) 797-9999
- Fax
- (510) 797-9783
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 20A4511 | CA | Primary |
Addresses
Primary practice location
2557 Mowry Ave
#30
Fremont, CA 94538
Mailing address
2557 Mowry Ave
#30
Fremont, CA 94538
Phone (510) 797-9999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX45110 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A4511 | CA | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740226000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2557 MOWRY AVE",
"address_2": "#30",
"city": "FREMONT",
"state": "CA",
"postal_code": "94538",
"telephone_number": "510-797-9999",
"fax_number": "510-797-9783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2557 MOWRY AVE",
"address_2": "#30",
"city": "FREMONT",
"state": "CA",
"postal_code": "94538",
"telephone_number": "510-797-9999",
"fax_number": "510-797-9783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLESON",
"first_name": "DALE",
"middle_name": "ALLAN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "CA",
"license": "20A4511",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX45110",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.