Provider Demographics
NPI:1972184893
Name:ELLIS GAVIN REEF
Entity Type:Organization
Organization Name:ELLIS GAVIN REEF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:REEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-317-7360
Mailing Address - Street 1:5885 AIRLINE RD UNIT 914
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5118
Mailing Address - Country:US
Mailing Address - Phone:901-317-7360
Mailing Address - Fax:901-317-7585
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-226-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114675Medicaid