Provider Demographics
NPI:1205872413
Name:ELLER, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1307
Mailing Address - Country:US
Mailing Address - Phone:408-961-2649
Mailing Address - Fax:408-244-6596
Practice Address - Street 1:2281 PARAGON DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1307
Practice Address - Country:US
Practice Address - Phone:408-961-2649
Practice Address - Fax:408-244-6596
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481870Medicaid
CAAW135XMedicare PIN
CAF85399Medicare UPIN
CA300100689Medicare PIN
CAAW135UMedicare PIN
CA00A481870Medicaid
CAAW135VMedicare PIN
CAAW135YMedicare PIN
CA00A481870Medicare PIN
CAAW135ZMedicare PIN
CAAW135TMedicare PIN