Healthcare Provider Details

I. General information

NPI: 1447334164
Provider Name (Legal Business Name): ERIN D. ELLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MADISON ST
SEATTLE WA
98104-3588
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2323
  • Fax: 206-386-2729
Mailing address:
  • Phone: 206-386-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00028959
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD00028959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: