Individual
DR. EVAN D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 NE MOTHER JOSEPH PL, SUITE 210, VANCOUVER, WA 98664-3299
(360) 254-6161
(360) 449-1139
Mailing address
200 NE MOTHER JOSEPH PL, SUITE 210, VANCOUVER, WA 98664-3299
(360) 254-6161
(360) 449-1139
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD60270460
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD60270460
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366559163
—
WA
Enumeration date
08/25/2006
Last updated
09/17/2012
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