Provider Demographics
NPI:1235588286
Name:ELLIS, DANIEL K (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-272-7494
Mailing Address - Fax:405-272-6985
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:STE 1000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-272-7494
Practice Address - Fax:405-272-6985
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK6156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine