Organization
JERI L ELLIS MD, MPH, PC
Active
Other names
Ellis Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE CATO (CONTRACTING MANAGER)
(405) 470-1884
Entity
Organization
Contact information
Practice address
420 N KICKAPOO AVE, SHAWNEE, OK 74801-6643
(400) 581-6331
Mailing address
5909 NW EXPRESSWAY STE 360, OKLAHOMA CITY, OK 73132-5149
(405) 470-1884
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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