Provider Demographics
NPI:1427089234
Name:ELLIS, BLESILDA Q (MD)
Entity type:Individual
Prefix:DR
First Name:BLESILDA
Middle Name:Q
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:1415 TULANE AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-8600
Practice Address - Fax:504-988-8688
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27022207RC0200X, 207RP1001X
LAMD.09330R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118449OtherMS MEDICAID
AL168326Medicaid
LA1972581Medicaid
AL512-05526OtherBCBS
AL211714Medicaid
AL213438Medicaid
AL5779364OtherAETNA
AL205842Medicaid
AL511-56775OtherBCBS
AL511-56774OtherBCBS
AL511-95544OtherBCBS
AL512-05528OtherBCBS
ALF68986OtherVIVA HEALTH
AL102I293263OtherMEDICARE
AL511-57064OtherBCBS
ALP01438825OtherRR MEDICARE
AL1730048OtherUHC
AL203245Medicaid
AL7718053OtherCIGNA HC