Individual
DR. STEVEN A ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2829
(417) 820-8852
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
117034
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050062220
RAILROAD MEDICARE
MO
05
—
135634001
—
AR
05
—
203823109
—
MO
01
—
431560263
TRICARE
MO
Enumeration date
01/30/2007
Last updated
10/02/2014
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