DR. MARK BRIAN ELLIS (NPI# 1083632244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083632244 |
| Entity Type | Individual |
| Full Name | DR. MARK BRIAN ELLIS |
| Credential | D.O. |
| Practice Address |
1018 Rucker Blvd Ste A Enterprise AL 36330-3675 |
| Practice Telephone | 3343474343 |
| Practice Fax Number | 3343939611 |
| Mailing Telephone | 3343474343 |
| Mailing Fax Number | 3343939611 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-04-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | DO463 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 009971495 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972897080 | Mark Ellis | Podiatrist | 12592 S 150 E, Draper, UT 84020-8611 | 2011-06-06 |
| 1659682219 | Mark Kenneth Ellis | Emergency Medicine | 2 5th Ave Apt 2d, New York, NY 10011-8832 | 2010-06-29 |
| 1174661672 | Mark Joseph Ellis | Chiropractor | 41 Western Avenue, Rochester, NH 03867 | 2007-02-05 |
| 1336204171 | Mark J Ellis | Respiratory Therapist, Certified | 1101 Jefferson Blvd, Hagerstown, MD 21742-5037 | 2006-12-22 |
| 1184719262 | Mark Allen Ellis | Dentist | 910 Averitt Rd, Greenwood, IN 46143-9540 | 2006-10-04 |
| 1437240124 | Mark Owen Ellis | Podiatrist | 582 22nd Street, Astoria, OR 97103 | 2006-09-27 |
| 1265426894 | Mark Alan Ellis | Dentist | 951 Riverfront Pkwy, Suite 302, Chattanooga, TN 37402-2185 | 2005-09-09 |
| 1316580509 | Mark Duane Ellis | Licensed Practical Nurse | 2600 Se Belmont St, Portland, OR 97214-2916 | 2019-10-21 |
| 1629427752 | Mark Andrew Ellis | Otolaryngology | 169 Ashley Ave, Room 202 Main Hospital, Msc 333, Charleston, SC 29425-9080 | 2016-06-09 |
| 1366808677 | Mark Ellis | Behavioral Analyst | 453 King St, Cocoa, FL 32922-7621 | 2016-01-04 |
| Street Address |
1018 RUCKER BLVD STE A |
| City | ENTERPRISE |
| State | AL |
| Zip Code | 36330-3675 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417566860 | Julia Brooke Lowe | Pharmacist | 847 Boll Weivell Circle #112, Enterprise, AL 36330 | 2020-07-30 |
| 1134759640 | Benjamin Chase Marler | Student in an Organized Health Care Education/Training Program | 205 Somerset Pl, Enterprise, AL 36330 | 2020-01-23 |
| 1033694492 | Angel Melton | Counselor | 105 Searcy St, Enterprise, AL 36330 | 2018-10-01 |
| 1285180729 | Enterprise Urgent Care | Clinic/Center | 6582 Boll Weevil Circle, Enterprise, AL 36330 | 2016-08-25 |
| 1902204258 | Nikki Chen | Nurse Practitioner | 805 East Lee Street, Ste C, Enterprise, AL 36330 | 2014-12-17 |
| 1568795417 | Crystal Juanita Christian | Counselor | 1275 James Drive, Suite A Enterprise Behavioral Services, Enterprise, AL 36330 | 2009-09-10 |
| 1316173206 | Robert Noback | Preventive Medicine | 301 Dustoff Ave, Ft. Rucker, AL 36330 | 2009-06-05 |
| 1184892978 | Phillip Allen Fuller | Pulmonary Function Technologist | 130e.pondella Dr., Enterprise, AL 36330 | 2008-02-14 |
| 1720266778 | Richard Bauer | Emergency Medical Technician, Intermediate | Bld 301 Andrews Ave., Lyster Army Health Clinic, Ft Rucker, AL 36330 | 2008-02-01 |
| 1871646547 | Thomas Orson Patterson | Dentist | 306 South Edwards Street, Enterprise, AL 36330 | 2007-01-18 |
| Find all providers in zip 36330 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750671665 | Anderson Physician Alliance, Inc. | Family Medicine | 83 Old Mill Creek Road, Enterprise, MS 39330-9649 | 2011-04-12 |
| 1528266392 | Lawrence Leonard Woods | Family Medicine | 107 Sw 1st St, Suite 104, Enterprise, OR 97828-1201 | 2007-07-03 |
| 1134130131 | David Nathaniel Arthur Ryan | Family Medicine | 1008 Boll Weevil Cir, Suite B, Enterprise, AL 36330-1312 | 2006-08-11 |
| 1134162092 | Lawrence Leonard Woods | Family Medicine | 107 Sw 1st St Ste 104, Enterprise, OR 97828-1285 | 2006-06-14 |
| 1124067632 | Walter J Lawrence | Family Medicine | 551 Glover Ave, Enterprise, AL 36330-2041 | 2006-06-06 |
| 1609821263 | Emily A Sheahan | Family Medicine | 616 W North St, Enterprise, OR 97828-1427 | 2006-05-23 |
| 1851349179 | Montgomery C Peden | Family Medicine | 101 Professional Lane, Enterprise, AL 36330 | 2006-05-05 |
| 1972575777 | Shean Eric Phelps | Family Medicine | 2 Cottage Ave, Enterprise, AL 36330-8552 | 2006-02-06 |
| 1710967500 | Howard Russell Cook | Family Medicine | 805 E Lee St, Ste C, Enterprise, AL 36330-2477 | 2006-01-18 |
| 1518426493 | Winding Waters Medical Clinic | Family Medicine | 758 Nw 1st St, Enterprise, OR 97828-1527 | 2019-03-19 |
| Find all providers in ENTERPRISE | ||||
| City | ENTERPRISE |
| Zip Code | 36330 |
Please comment or provide details below to improve the information on DR. MARK BRIAN ELLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.