Provider Demographics
NPI:1821222456
Name:ELLSWORTH, DUANE EDMUND (DO)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:EDMUND
Last Name:ELLSWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 E MCDOWELL RD
Mailing Address - Street 2:CANYON STATE ANESTHESIOLOGY
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8102 E MCDOWELL RD
Practice Address - Street 2:CANYON STATE ANESTHESIOLOGY
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3809
Practice Address - Country:US
Practice Address - Phone:480-421-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62825390200000X
AZ006049207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program