Individual
CHARLES T. ELLIS
Active
Individual
CHARLES T. ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11196
MT
2084P0800X
Psychiatry Physician
MD60191799
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000914460
BLUE CROSS-SHIELD OF MONTANA
MT
Enumeration date
12/01/2006
Last updated
04/01/2015
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