Individual
MRS. BRENDA RENEE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7271 N MAIN ST, SUITE 3, DAYTON, OH 45415-2567
(937) 277-9130
(937) 277-9165
Mailing address
7271 N MAIN ST, SUITE 3, DAYTON, OH 45415-2567
(937) 277-9130
(937) 277-9165
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-05-8696
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0753215
—
OH
Enumeration date
07/24/2006
Last updated
01/06/2012
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