Provider Demographics
NPI:1235116492
Name:ELLZEY, BARBARA A (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:ELLZEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 CONWAY WOLD BYWAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11123 S TOWNE SQ
Practice Address - Street 2:SUITE E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7816
Practice Address - Country:US
Practice Address - Phone:314-487-4537
Practice Address - Fax:314-487-8971
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116352Medicaid
MO1235116492Medicaid
MO147400007Medicare PIN
MO1235116492Medicaid
IL036116352Medicaid