Individual
ROBERT GREG ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA575
ME
363AS0400X
Surgical Physician Assistant
Primary
PA575
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912927971
—
ME
01
—
AP185001
MEDICARE PTAN
ME
Enumeration date
07/20/2006
Last updated
06/30/2023
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