Healthcare Provider Details

I. General information

NPI: 1720056823
Provider Name (Legal Business Name): ROBERT J ELLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE SUITE 600
SPRINGFIELD MO
65807-5287
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-4880
  • Fax: 417-882-7843
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberR8N50
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR8N50
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: