Individual
DR. MARK BRIAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1018 RUCKER BLVD, STE A, ENTERPRISE, AL 36330-3675
(334) 347-4343
(334) 393-9611
Mailing address
1018 RUCKER BLVD, STE A, ENTERPRISE, AL 36330-3675
(334) 347-4343
(334) 393-9611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO463
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009971495
—
AL
Enumeration date
07/17/2006
Last updated
04/04/2018
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