Active NPI
Barry Ellis London, MD
- Pediatrics Physician
- Tucson, AZ
National Provider Identifier
1083785331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 41335
- Practice address
- 2600 N Wyatt Dr
Children'S Clinics
Tucson, AZ 85712-6106 - Phone
- (520) 324-5437
- Fax
- (520) 324-3129
- NPI assigned
- Nov 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 41335 | AZ | Primary |
Addresses
Primary practice location
2600 N Wyatt Dr
Children'S Clinics
Tucson, AZ 85712-6106
Mailing address
2600 N Wyatt Dr
Children'S Clinics
Tucson, AZ 85712-6106
Phone (520) 324-5437
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 396294 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357689600000",
"number": "1083785331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 N WYATT DR",
"address_2": "CHILDREN'S CLINICS",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857126106",
"telephone_number": "520-324-5437",
"fax_number": "520-324-3129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 N WYATT DR",
"address_2": "CHILDREN'S CLINICS",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857126106",
"telephone_number": "520-324-5437",
"fax_number": "520-324-3129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONDON",
"first_name": "BARRY",
"middle_name": "ELLIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-10",
"last_updated": "2013-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "41335",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "396294",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.