Ear Nose and Throat Medical Group

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

EAR NOSE AND THROAT MEDICAL GROUP

Practice address

805 Veterans Blvd Ste 115
Redwood City, CA 94063-1755

Phone

(650) 369-1619

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. David Ellison, M.D.

Title

M.D.

Phone

(650) 344-6896

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Ear Nose and Throat Associates of San Mateo County Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ear, Nose and Throat Associates of San Mateo County Inc

  • Otolaryngology Physician
  • San Mateo, CA
  • NPI 1699792598
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Bock-Hughes, M.D.

  • Otolaryngology Physician
  • San Mateo, CA
  • NPI 1033136916
  NPD

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770700502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S ELLSWORTH AVE STE 308",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013931",
            "telephone_number": "650-344-6896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 VETERANS BLVD STE 115",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631755",
            "telephone_number": "650-369-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE AND THROAT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "650-344-6896",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ80557Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie Therese Duran-Whitney, PSYD
• Pauline Enriqueta Duran, RN
• Robert Durazzo, MFT
• Walter G. Eades, MD
• Richard Alan Eagleston
• Wayne L. Easter, MD
• Sarah Easton, LCSW
• Jacqueline Marie Eaton, MFT-I
• Mojgan Ebadi, M.D.
• Manuel Victor Ebejer, CATC INTERN

• Otolaryngology Physician in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.