Basic Information
| Provider Information | |||||||||
| NPI: | 1487738928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLIS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 NE 10TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052328003 | ||||||||
| FaxNumber: | 4052328008 | ||||||||
| Practice Location | |||||||||
| Address1: | 1226 N SHARTEL AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052328003 | ||||||||
| FaxNumber: | 4052328008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 15874 | OK | N | Hospitals | General Acute Care Hospital | 207LP2900X | 15874 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.