Provider Demographics
NPI:1578664744
Name:ELLIS, CHRISTOPHER CHARLES (PA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:ELLIS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 1880
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1880
Mailing Address - Country:US
Mailing Address - Phone:559-585-6868
Mailing Address - Fax:559-585-0911
Practice Address - Street 1:470 GREENFIELD AVE
Practice Address - Street 2:STE 35
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3513
Practice Address - Country:US
Practice Address - Phone:559-584-3000
Practice Address - Fax:559-583-8456
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 18256363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical