# DR. MARK ELLIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1972897080
- **Gender:** Man
- **Credential:** DPM

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213EP0504X | Public Medicine Podiatrist | 10105797-0501 | UT | — |
| 213ER0200X | Radiology Podiatrist | 10105797-0501 | UT | — |
| 213ES0000X | Sports Medicine Podiatrist | 10105797-0501 | UT | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 0821 | AZ | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 10105797-0501 | UT | — |

## Other

- **Enumeration date:** 06/06/2011
- **Last updated:** 06/10/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 367438 | — | AZ |