Provider Demographics
NPI:1679785141
Name:JOHN A ELLERTON MD.LTD DBA CANCER CONSULTANTS
Entity Type:Organization
Organization Name:JOHN A ELLERTON MD.LTD DBA CANCER CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:ELLERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-384-0808
Mailing Address - Street 1:2020 W. PALOMINO LN
Mailing Address - Street 2:SUITE #110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4812
Mailing Address - Country:US
Mailing Address - Phone:702-384-0808
Mailing Address - Fax:702-384-9329
Practice Address - Street 1:2020 W. PALOMINO LN
Practice Address - Street 2:SUITE #110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4812
Practice Address - Country:US
Practice Address - Phone:702-384-0808
Practice Address - Fax:702-384-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3861207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWCGVQ02Medicare ID - Type Unspecified