Healthcare Provider Details

I. General information

NPI: 1235116492
Provider Name (Legal Business Name): BARBARA A ELLZEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 S TOWNE SQ SUITE E
SAINT LOUIS MO
63123-7816
US

IV. Provider business mailing address

424 CONWAY WOLD BYWAY
SAINT LOUIS MO
63141-8637
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-4537
  • Fax: 314-487-8971
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR9742
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: