Individual
CLYDE NEAL ELLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
812 GORMAN AVE, ELKINS, WV 26241-3181
(304) 636-3300
(304) 636-4331
Mailing address
6833 BAY RD, MOBILE, AL 36605-9643
(251) 281-4502
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35220
WV
208600000X
Surgery Physician
Primary
R8884
TX
208C00000X
Colon & Rectal Surgery Physician
19367
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093762908
—
NV
Enumeration date
05/27/2006
Last updated
07/27/2026
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