Provider Demographics
NPI:1982792750
Name:ELLIS, JAMES K (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-449-4642
Mailing Address - Fax:985-449-2560
Practice Address - Street 1:608 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-449-4642
Practice Address - Fax:985-449-2560
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA021233207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932205Medicaid
LA721245423OtherUNITED HEALTHCARE
LA1932205Medicaid
LAF32728Medicare UPIN