Individual
CHRISTOPHER ROBERT ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
344 NW 97TH AVE, PLANTATION, FL 33324-7069
(843) 455-2345
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
T-5288
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2024
Last updated
07/15/2024
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