Ellis, Russell L

Ellis, Russell L is an individual health care provider with primary practice located at 1103 16Th Ave Se , Decatur AL 35601-3595. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Ellis, Russell L can be contacted via phone (256) 350-0362.

Contact Information

Primary practice address
1103 16Th Ave Se Decatur AL 35601-3595
Phone: (256) 350-0362
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 2081S0010X 00022020 Alabama

Profile Details

NPI number 1134292766
LBN Legal business name Ellis, Russell L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2006
Last updated Oct 22nd, 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 1134292766 NPPES
Alabama Other 51507394 BLUECROSS BLUESHIELD OF A

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