Jeri L Ellis Md, Mph, PC

NPI #1538672001 in Shawnee, Oklahoma

Provider Information

NPI Number: 1538672001
Entity Type: Organization
Organization Name: Jeri L Ellis Md, Mph, PC
Primary Specialty: Clinic/Center - Primary Care
Enumeration Date: Nov 7, 2017
Last Updated: Nov 7, 2017

Practice Location

Address: 420 N KICKAPOO AVE
City: Shawnee
State: Oklahoma
ZIP Code: 74801-6643
Phone: (400) 581-6331

Authorized Official

Name: DENISE CATO
Title: CONTRACTING MANAGER
Phone: (405) 470-1884

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine - Adult Medicine — Adult Medicine	207QA0505X
Clinic/Center - Primary Care — Primary Care	261QP2300X	Primary

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