Dr. Mark Gregory Ellis
Pediatrician
2200 Tydd St
Eureka
, California 95501-1284
Dr. Mark Gregory Ellis
Pediatrician
2200 Tydd St
Eureka
, California 95501-1284
(707) 826-8638
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Dr. Mark Gregory Ellis
- 670 9th St Ste 203
- Arcata, CA
- Zip : 95521-6249
- Fax : (707) 826-8638
- Phone : (707) 826-8633
Second Address
- Dr. Mark Gregory Ellis
- 2200 Tydd St
- Eureka, CA
- Zip : 95501-1284
- Fax : (707) 269-7054
- Phone : (707) 269-7051
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | G65432 | CA |
National Provider Identifier
| NPI | 1003812744 |
|---|---|
| Provider Name | Dr. Mark Gregory Ellis |
| First Address | Arcata, CA 95521-6249 |
| Second Address | Eureka, CA 95501-1284 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/06/2005 |
| Last Update Date | 17/03/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| F16252 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.