Provider Demographics
NPI:1194861963
Name:JAMES, ELLIS J
Entity type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:J
Last Name:JAMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3093 TESS AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2818
Mailing Address - Country:US
Mailing Address - Phone:503-391-4452
Mailing Address - Fax:
Practice Address - Street 1:3093 TESS AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2818
Practice Address - Country:US
Practice Address - Phone:503-391-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator