Ellis, Mark Brian
Ellis, Mark Brian is an individual health care provider with primary practice located at 1018 Rucker Blvd Ste A, Enterprise AL 36330-3675. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ellis, Mark Brian can be contacted via phone (334) 347-4343.Contact Information
Primary practice address
1018 Rucker Blvd Ste A
Enterprise AL 36330-3675
Phone: (334) 347-4343
Fax: (334) 393-9611
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | DO463 | Alabama |
Profile Details
| NPI number | 1083632244 |
|---|---|
| LBN Legal business name | Ellis, Mark Brian |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 17th, 2006 |
| Last updated | Apr 4th, 2018 - about 8 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 | 1083632244 | NPPES |
| Alabama | MEDICAID | 009971495 |
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