Ellis, Ezra Daniel
Ellis, Ezra Daniel is an individual health care provider with primary practice located at 743 Spring St Ne , Gainesville GA 30501-3715. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Ellis, Ezra Daniel can be contacted via phone (770) 219-1136.Contact Information
Primary practice address
743 Spring St Ne
Gainesville GA 30501-3715
Phone: (770) 219-1136
Fax: (770) 219-6204
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | M-10161 | Idaho |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 2007-00176 | North Carolina |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 70094 | Georgia |
Profile Details
| NPI number | 1164602611 |
|---|---|
| LBN Legal business name | Ellis, Ezra Daniel |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 13th, 2007 |
| Last updated | Oct 28th, 2019 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164602611 | NPPES |
| Idaho | Other | 000010167581 | REGENCE BLUESHIELD OF IDAHO |
| Idaho | Other | 77342 | REGENCE BLUESHIELD OF IDAHO |
| Idaho | MEDICAID | 808087600 | REGENCE BLUESHIELD OF IDAHO |
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