Individual
DARYL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5009 RIVER CHASE DR, SUITE 500, PHENIX CITY, AL 36867-7425
(334) 448-9505
(334) 448-9575
Mailing address
5009 RIVERCHASE DR, SUITE 500, PHENIX CITY, AL 36867-7490
(334) 448-9505
(334) 448-9575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00018084
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009997735
—
AL
Enumeration date
07/31/2006
Last updated
11/21/2012
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