Individual
KELVIN ELLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6300 MAIN ST, ZACHARY, LA 70791-4037
(225) 658-4316
Mailing address
3600 FORBES AVE, PITTSBURGH, PA 15213-3410
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
315779
NY
207P00000X
Emergency Medicine Physician
Primary
346884
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2018
Last updated
03/13/2026
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