Ellis, Randall E

Ellis, Randall E is an individual health care provider with primary practice located at 2320 Wilma Rudolph Blvd , Clarksville TN 37040-5821. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Ellis, Randall E can be contacted via phone (931) 645-1564.

Contact Information

Primary practice address
2320 Wilma Rudolph Blvd Clarksville TN 37040-5821
Phone: (931) 645-1564
Fax: (931) 645-3842
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD27444 Tennessee

Profile Details

NPI number 1396784138
LBN Legal business name Ellis, Randall E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 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 1396784138 NPPES
Tennessee Other 4041098 BLUECROSS BLUESHIELD

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