Ellis, Bobby J
Ellis, Bobby J is an sole proprietor health care provider with primary practice located at 921 14Th Ave Nw , Ardmore OK 73401-1837. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Ellis, Bobby J can be contacted via phone (580) 223-5311.Contact Information
Primary practice address
921 14Th Ave Nw
Ardmore OK 73401-1837
Phone: (580) 223-5311
Fax: (580) 223-8227
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 0417821 | Kansas |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 26021 | Oklahoma |
Profile Details
| NPI number | 1679595144 |
|---|---|
| LBN Legal business name | Ellis, Bobby J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 24th, 2006 |
| Last updated | Apr 29th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679595144 | NPPES |
| Oklahoma | MEDICAID | 200128140A |
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