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Individual

ROBERT GREG ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
46 FAIRVIEW AVE STE 223, SKOWHEGAN, ME 04976-1481
(207) 474-7045
(207) 474-5173
Mailing address
PO BOX 468, SKOWHEGAN, ME 04976-0468
(207) 858-8367
(207) 474-9261

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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