Organization
DR MARK F ELLIS DPMA PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ELLIS DPM (PHYSICIAN)
(337) 593-1278
Entity
Organization
Contact information
Practice address
913 S COLLEGE RD STE 216B, LAFAYETTE, LA 70503-3060
(337) 593-1278
(337) 593-1280
Mailing address
501 W SAINT MARY BLVD, STE 520, LAFAYETTE, LA 70506-4600
(337) 593-1278
(337) 593-1280
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
1670511
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1670511
—
LA
Enumeration date
06/01/2006
Last updated
08/20/2024
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