Individual
COLETTE MARK ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1059 BAYWOOD DR, FAIRBORN, OH 45324-2647
(713) 339-0341
Mailing address
1059 BAYWOOD DR, FAIRBORN, OH 45324-2647
(713) 339-0341
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
S8030
TX
208D00000X
General Practice Physician
Primary
S8030
TX
Other
Enumeration date
04/02/2019
Last updated
07/27/2022
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