Provider Demographics
NPI:1033204490
Name:CORDRAY, ELLISON H (MD)
Entity Type:Individual
Prefix:
First Name:ELLISON
Middle Name:H
Last Name:CORDRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3116 W MARCH LANE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2370
Mailing Address - Country:US
Mailing Address - Phone:209-473-6555
Mailing Address - Fax:209-473-6544
Practice Address - Street 1:1800 NO CALIFORNIA STREET
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-0000
Practice Address - Country:US
Practice Address - Phone:209-473-6555
Practice Address - Fax:209-473-6544
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG66464207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66464OtherCA MEDICAL LICENSE
CAG66464OtherCA MEDICAL LICENSE