Ellis, Mark D.

Ellis, Mark D. is an individual health care provider with primary practice located at 208 Haley Rd , Johnson City TX 78636-4617. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Ellis, Mark D. can be contacted via phone (830) 868-9500.

Contact Information

Primary practice address
208 Haley Rd Johnson City TX 78636-4617
Phone: (830) 868-9500
Fax: (830) 868-4606
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 609633 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP108475 Texas

Profile Details

NPI number 1508868530
LBN Legal business name Ellis, Mark D.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Aug 10th, 2021 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508868530 NPPES
Texas Other 8N3533 BLUE CROSS BLUE SHIELD

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