Individual
DANIEL ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 JACKSON ST, LAKE CHARLES, LA 70601-2458
(337) 488-9560
Mailing address
1400 JACKSON ST, LAKE CHARLES, LA 70601-2458
(337) 488-9560
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
010630340
LA
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
About Stedi
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