Individual
WILLIAM D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8300 CONSTITUTION AVE NE, PMG EMERGENCY MEDICINE, ALBUQUERQUE, NM 87110-7613
(505) 291-2122
(505) 291-2979
Mailing address
PO BOX 26666, PRESBYTERIAN HEALTHCARE SERVICES - PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2015-0028
NM
390200000X
Student in an Organized Health Care Education/Training Program
390200000
NM
Other
Enumeration date
03/19/2012
Last updated
03/16/2015
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