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Contact Information

MARK O ELLIS, DPM
582 22ND STREET
ASTORIA, OR97103
 Phone: 503-325-0045
 Fax: 503-325-3242
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MARK O ELLIS · (Male)

NPI # 1437240124
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 09/27/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • OR License # DP00095
  • OR Medicaid 056416
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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