Provider Demographics
NPI:1508980582
Name:ELLIS, SCOTT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20605
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0605
Mailing Address - Country:US
Mailing Address - Phone:480-503-3055
Mailing Address - Fax:480-503-3066
Practice Address - Street 1:726 N GREENFIELD RD STE 108
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5062
Practice Address - Country:US
Practice Address - Phone:480-503-3055
Practice Address - Fax:480-503-3066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27064207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine