Individual
KENNETH R ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1213 24TH ST, SUITE 300, ANACORTES, WA 98221-2592
(360) 293-2020
(360) 299-0341
Mailing address
1213 24TH ST, SUITE 300, ANACORTES, WA 98221-2592
(360) 293-2020
(360) 299-0341
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD00041277
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0163027
L AND I
—
05
—
8351454
—
WA
Enumeration date
05/19/2006
Last updated
07/30/2008
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