Ellis, Mark H

Ellis, Mark H is an individual health care provider with primary practice located at 1234 Empire St , Fairfield CA 94533-5711. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Infectious Disease. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Ellis, Mark H can be contacted via phone (707) 426-3911.

Contact Information

Primary practice address
1234 Empire St Fairfield CA 94533-5711
Phone: (707) 426-3911
Fax: (707) 434-2043
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A26035 California
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X A26035 California

Profile Details

NPI number 1144317462
LBN Legal business name Ellis, Mark H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 6th, 2006
Last updated Jul 8th, 2007 - about 18 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 1144317462 NPPES
California MEDICAID 00A260350

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