Individual
ALVAN L ELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
203 N DIVISION ST, FLORA, IN 46929-1024
(765) 448-8000
(765) 448-8335
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01022721A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183530
ANTHEM PROVIDER NUMBER
IN
05
—
100097620
—
IN
01
—
10825048
CAQH NUMBER
IN
01
—
9057268
PHCS PID NUMBER
IN
05
—
EL17837008
—
IN
Enumeration date
03/14/2006
Last updated
09/29/2008
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