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Individual

DR. PAUL D ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
130 W RAVINE RD, KINGSPORT, TN 37660
(423) 968-1144
Mailing address
3053 W STATE ST, BRISTOL, TN 37620-1720

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
39706
KY
2085R0202X
Diagnostic Radiology Physician
Primary
40098
TN
2085R0202X
Diagnostic Radiology Physician
ME103342
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3336612
TN
01
P00278836
RAILROAD MEDICARE
TN
Enumeration date
05/01/2006
Last updated
11/14/2018
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