Individual
DR. RICHARD K ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
148 SAULS ST, LAKE CITY, SC 29560-2631
(843) 374-3621
(843) 374-3624
Mailing address
PO BOX 118008, CHARLESTON, SC 29423-8008
(843) 374-3621
(843) 374-3624
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21182
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211826
—
SC
01
—
P01055600
RR PTAN
SC
Enumeration date
09/16/2006
Last updated
12/04/2013
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