Individual
MR. ROBERT ELLSWORTH ELLIS
Active
Individual
MR. ROBERT ELLSWORTH ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19194
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047003
ANTHEM
KY
01
—
1058692
PASSPORT
KY
01
—
110000678
MEDICARE RR
KY
01
—
2433985000
PASSPORT ADVANTAGE
KY
05
—
64191943
—
KY
Enumeration date
05/05/2006
Last updated
08/13/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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