Provider Demographics
NPI:1356491997
Name:ELLIS, TROY C (MD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:C
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13943 N 91ST AVE
Mailing Address - Street 2:#C-101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3629
Mailing Address - Country:US
Mailing Address - Phone:623-760-9449
Mailing Address - Fax:623-974-9351
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:#C-101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3629
Practice Address - Country:US
Practice Address - Phone:623-760-9449
Practice Address - Fax:623-974-9351
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ49391207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4847313OtherAETNA
AZ1356491997OtherBC/BS
AZ2868924OtherCIGNA
AZ2868924OtherCIGNA