Individual
DR. DUSTIN CLAY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2186 N HOSPITAL BLVD STE 2, SULLIVAN, IN 47882-7654
(812) 268-3318
Mailing address
PO BOX 230, 2229 MARY SHERMAN DRIVE, SULLIVAN, IN 47882-0230
(812) 268-3318
(812) 268-4017
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11013685A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015680A
—
IN
Enumeration date
08/11/2008
Last updated
04/27/2021
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