| Doctor Name: | DR. RICHARD J. ELLISTON |
| NPI Number: | 1205844685 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | PO163 |
| Business Practice Address: | 600 Caisson Hill Road Irwin Army Community Hospital, Fort Riley, KS - 664425037 |
| Business Phone Number: | 7852397155 |
| Business Fax Number: | 7852397364 |
| Mailing Address: | Irwin Army Community Hospital, 600 Caisson Hill Road, Attn: Mcxx-cld-qm (cred) Terry Hill FORT RILEY |
| State: | KS |
| Postal Code: | 664425037 |
| Phone Number: | 7852397155 |
| Fax Number: | 7852397364 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | PO163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |