Carl Richard Ellis DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

CARL RICHARD ELLIS DPM

Practice address

416 Juniper Dr
Crestview, FL 32536-9223

Phone

(850) 682-1778

NPI assigned

Nov 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carl Richard Ellis, DPM

Title

Owner

Phone

(850) 682-1778

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315958400000",
    "number": "1992985782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 JUNIPER DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325369223",
            "telephone_number": "850-682-1778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 JUNIPER DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325369223",
            "telephone_number": "850-682-1778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARL RICHARD ELLIS DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2011-09-14",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-682-1778",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wayne E. Campbell, M.D.
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• Carlos Mata P.a.
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• Jazzmin Carter
• Jennifer Lehman Carter, OT

• Podiatrist in Crestview, FL
• Providers in Crestview, FL by specialty
• Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.