Ellis, Dustin Clay
Ellis, Dustin Clay is an individual health care provider with primary practice located at 2186 N Hospital Blvd Ste 2 , Sullivan IN 47882-7654. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ellis, Dustin Clay can be contacted via phone (812) 268-3318.Contact Information
Primary practice address
2186 N Hospital Blvd Ste 2
Sullivan IN 47882-7654
Phone: (812) 268-3318
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 11013685A | Indiana |
Profile Details
| NPI number | 1962658989 |
|---|---|
| LBN Legal business name | Ellis, Dustin Clay |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 11th, 2008 |
| Last updated | Apr 27th, 2021 - about 3 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 | 1962658989 | NPPES |
| Indiana | MEDICAID | 200015680A |
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