Individual
DR. ANDREW JAMES ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5643
(314) 268-4019
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5643
(314) 268-4019
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01078376
IN
208000000X
Pediatrics Physician
Primary
2018012696
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11017649A
STATE MEDICAL LICENSE
IN
Enumeration date
05/29/2014
Last updated
09/19/2022
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