| Doctor Name: | RICHARD LEROY ELLIS |
| NPI Number: | 1104010206 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | DO145 |
| Business Practice Address: | 2657 Park Lane Ct East--unit F Birmingham, AL - 35223 |
| Business Phone Number: | 2058791386 |
| Business Fax Number: | |
| Mailing Address: | 2657 Park Lane Ct East--unit F, BIRMINGHAM |
| State: | AL |
| Postal Code: | 35223 |
| Phone Number: | 2058791386 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2007 |
| NPI Last Update Date: | 08/31/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | DO145 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |