Individual
ELLERY MEREDITH JAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
22381
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300008938
RAILROAD MEDICARE
MN
05
—
35173200
—
WI
05
—
430713500
—
MN
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
SD
Enumeration date
01/20/2006
Last updated
12/27/2012
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