Individual
MARK ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
501 W SAINT MARY BLVD, SUITE B, LAFAYETTE, LA 70506-4600
(337) 593-1278
(337) 593-1280
Mailing address
501 W SAINT MARY BLVD, SUITE B, LAFAYETTE, LA 70506-4600
(337) 593-1278
(337) 593-1280
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
1670511
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1670511
—
LA
Enumeration date
06/03/2006
Last updated
09/05/2008
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