Ellis, Evan D

Ellis, Evan D is an individual health care provider with primary practice located at 200 Ne Mother Joseph Pl Suite 210, Vancouver WA 98664-3299. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Ellis, Evan D can be contacted via phone (360) 254-6161.

Contact Information

Primary practice address
200 Ne Mother Joseph Pl Suite 210 Vancouver WA 98664-3299
Phone: (360) 254-6161
Fax: (360) 449-1139
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD60270460 Washington
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X MD60270460 Washington

Profile Details

NPI number 1366559163
LBN Legal business name Ellis, Evan D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2006
Last updated Sep 17th, 2012 - about 13 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 1366559163 NPPES
Washington MEDICAID 1366559163

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