Provider Demographics
NPI:1730751454
Name:MARC ELLMAN, M.D., P.A.
Entity type:Organization
Organization Name:MARC ELLMAN, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-598-7488
Mailing Address - Street 1:63 S ROCKFORD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-6226
Mailing Address - Country:US
Mailing Address - Phone:602-598-7488
Mailing Address - Fax:602-231-6215
Practice Address - Street 1:2301 SATURN CIR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7727
Practice Address - Country:US
Practice Address - Phone:915-267-2020
Practice Address - Fax:915-595-4460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARC ELLMAN, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty