Individual
KENNETH E ELLINGWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3719 DAUPHIN ST, SUITE 100, MOBILE, AL 36608-1753
(251) 414-5665
(251) 414-5571
Mailing address
3719 DAUPHIN ST, SUITE 100, MOBILE, AL 36608-1753
(251) 414-5665
(251) 414-5571
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00008683
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000014586
—
AL
01
—
1134111537
NPI
—
01
—
920002054
RR MEDICARE
AL
Enumeration date
08/22/2005
Last updated
04/02/2020
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