Ellis, Mark
Ellis, Mark is an individual health care provider with primary practice located at 501 W Saint Mary Blvd Suite B, Lafayette LA 70506-4600. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as his primary health care specialty. Ellis, Mark can be contacted via phone (337) 593-1278.Contact Information
Primary practice address
501 W Saint Mary Blvd Suite B
Lafayette LA 70506-4600
Phone: (337) 593-1278
Fax: (337) 593-1280
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Foot Surgery | 213ES0131X | 1670511 | Louisiana |
Profile Details
| NPI number | 1215975891 |
|---|---|
| LBN Legal business name | Ellis, Mark |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 3rd, 2006 |
| Last updated | Sep 5th, 2008 - about 16 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 | 1215975891 | NPPES |
| Louisiana | MEDICAID | 1670511 |
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