Most Relevant Information
Provider Data
| NPI Number: | 1003221037 |
| Provider Name: | JOHN ELLIS D.O. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/28/2014 |
| Last Updated: | 01/19/2022 |
Provider Practice Location
4422 THIRD AVE
BRONX
NY
10457
Practice Location Phone/Fax
| Phone: | 7189609000 |
| Fax: |
Provider Mailing Location
6751 EAGLE RIDGE BLVD
LAKELAND
FL
338135636
Provider Mailing Phone/Fax
| Phone: | 7274176369 |
| Fax: | 9543773042 |