Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD00026526 | WA |
NPI | 1043287980 |
---|---|
Provider Name | Michael Robin Ellen |
First Address | Port Angeles, WA 98362-0146 |
Second Address | Port Angeles, WA 98362-3911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 18/05/2021 |