Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3660 | OK |
Y | 208200000X | Surgeon | 3660 | OK |
Y | 208600000X | Surgeon | 3660 | OK |
NPI | 1205832607 |
---|---|
Provider Name | Dr. Christian Ellis |
First Address | Oklahoma City, OK 73134-1785 |
Second Address | Oklahoma City, OK 73120-8366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 31/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200084540A | (05) | OK |
P00690379 | RR MEDICARE (01) |