Individual
BOBBY J ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
921 14TH AVE NW, ARDMORE, OK 73401-1837
(580) 223-5311
(580) 223-8227
Mailing address
4401 W MEMORIAL RD, 140, OKLAHOMA CITY, OK 73134-1785
(405) 752-3162
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0417821
KS
207R00000X
Internal Medicine Physician
Primary
26021
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200128140A
—
OK
Enumeration date
07/24/2006
Last updated
04/29/2014
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