Individual
PATRICK BOONE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
226 W GRAY ST STE 214, NORMAN, OK 73069-7132
(405) 701-5666
(405) 701-5667
Mailing address
520 24TH AVE S.W., NORMAN, OK 73069-5106
(405) 701-5666
(405) 701-5667
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3351
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100138180B
—
OK
Enumeration date
07/07/2006
Last updated
09/28/2022
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