Individual
DEMETRIUS J ELLIS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 S GARNETT RD STE G, TULSA, OK 74128-1838
(918) 878-7877
(918) 878-7882
Mailing address
5201 S WESTERN AVE, OKLAHOMA CITY, OK 73109-4526
(405) 632-0870
(918) 878-7872
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/24/2014
Last updated
02/24/2014
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