RICHARD LEROY ELLIS MD NPI 1104010206

General Practice in Birmingham, AL

Individual Male General Practice

About RICHARD ELLIS

Richard Ellis is a provider in Birmingham, AL. The NPI number assigned to this provider is 1104010206. The practitioner's primary taxonomy code is General Practice (208D00000X). The provider is registered as an individual and their NPI record was last updated 12 years ago.

NPI

1104010206

Provider Name RICHARD LEROY ELLIS MD
Provider Location Address2657 PARK LANE CT EAST--UNIT F BIRMINGHAM, AL 35223
Provider Mailing Address2657 PARK LANE CT EAST--UNIT F BIRMINGHAM, AL 35223
GenderMale
NPI Entity TypeIndividual
Is Sole Proprietor?Yes
Is Organization Subpart?N/A
Enumeration Date08-31-2007
Last Update Date08-31-2007

Primary Taxonomy

Taxonomy Code208D00000X
ClassificationGeneral Practice
TypeAllopathic & Osteopathic Physicians
License No.DO145
License StateAL

Business Address

RICHARD LEROY ELLIS MD
2657 PARK LANE CT EAST--UNIT F
BIRMINGHAM, AL
ZIP 35223
Phone: (205) 879-1386

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Mailing Address

RICHARD LEROY ELLIS MD
2657 PARK LANE CT EAST--UNIT F
BIRMINGHAM, AL
ZIP 35223
Phone: (205) 879-1386

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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