Individual
RICHARD ALAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7705 POPLAR AVE, SUITE 310, GERMANTOWN, TN 38138-3930
(901) 516-6300
(901) 516-6350
Mailing address
965 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9401
(901) 227-4692
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
16474
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6042000
BCBS
TN
05
—
Q014601
—
TN
Enumeration date
05/03/2006
Last updated
01/05/2024
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