Ellis, Richard Alan

Ellis, Richard Alan is an individual health care provider with primary practice located at 7705 Poplar Ave Suite 310, Germantown TN 38138-3930. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Ellis, Richard Alan can be contacted via phone (901) 516-6300.

Contact Information

Primary practice address
7705 Poplar Ave Suite 310 Germantown TN 38138-3930
Phone: (901) 516-6300
Fax: (901) 516-6350
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 16474 Tennessee

Profile Details

NPI number 1174581623
LBN Legal business name Ellis, Richard Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Jan 5th, 2024 - about 2 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 1174581623 NPPES
Tennessee MEDICAID Q014601
Tennessee Other 6042000

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