Individual
MR. GARY ELLIS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 20TH ST, HUNTINGTON, WV 25703-1810
(681) 378-3908
Mailing address
243 8TH AVE W APT 8, HUNTINGTON, WV 25701-2541
(304) 840-6328
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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