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Individual
DR. RUSTY TODD ELLIS
Active
Individual
DR. RUSTY TODD ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
43074
KY
208M00000X
Hospitalist Physician
Primary
43074
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000633242
ANTHEM
KY
01
—
50026571
PASSPORT
KY
05
—
7100094070
—
KY
Enumeration date
02/28/2007
Last updated
12/04/2020
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