Individual
MR. ELLIS TAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
41308
TN
208200000X
Plastic Surgery Physician
9601744
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89100200
—
NC
Enumeration date
04/17/2006
Last updated
02/06/2020
Update your record
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