Provider Demographics
NPI:1700828613
Name:ELLIS, GEORGE S JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:ELLIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:SUITE 3106
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-896-9426
Mailing Address - Fax:504-896-9312
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:SUITE 3106
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-9426
Practice Address - Fax:504-896-9312
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1331660Medicaid
LAB63068Medicare UPIN
LA51441Medicare ID - Type Unspecified