Individual
MARK H ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1234 EMPIRE ST, FAIRFIELD, CA 94533-5711
(707) 426-3911
(707) 434-2043
Mailing address
PO BOX 255668, SACRAMENTO, CA 95865-5668
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A26035
CA
207RI0200X
Infectious Disease Physician
Primary
A26035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A260350
—
CA
Enumeration date
10/06/2006
Last updated
09/11/2025
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