Individual
DR. JONATHAN EDWARD ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 FISHER ST, BILOXI, MS 39534-2508
(228) 376-0452
Mailing address
301 FISHER ST, BILOXI, MS 39534-2508
(228) 376-0452
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
24142
NE
Other
Enumeration date
04/11/2007
Last updated
07/09/2012
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