Organization
JERI ELLIS MD MPH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERI ELLIS M.D. (OWNER)
(405) 604-9595
Entity
Organization
Contact information
Practice address
5835 S PENNSYLVANIA AVE, OKLAHOMA CITY, OK 73119-7001
(405) 816-3311
(405) 634-7577
Mailing address
5835 S PENNSYLVANIA AVE, OKLAHOMA CITY, OK 73119-7001
(405) 816-3311
(405) 634-7577
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20048
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049610A
—
OK
05
—
200075590B
—
OK
01
—
569535528001
BCBS
OK
Enumeration date
01/16/2007
Last updated
05/02/2014
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