Individual
GARY D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4881 SUGAR MAPLE DR, 88MDG/MDOS/SGOW WRIGHT PATTERSON AFB, DAYTON, OH 45433-5529
(937) 257-6876
Mailing address
2489 EDGEWATER DR, UNIT 2, BEAVERCREEK, OH 45431-5644
(740) 274-1826
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/28/2013
Last updated
08/28/2013
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