Ellis, Ethan R

Ellis, Ethan R is an individual health care provider with primary practice located at 2121 E Harmony Rd Ste 100, Fort Collins CO 80528-3400. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology is his primary health care specialty. Ellis, Ethan R can be contacted via phone (970) 221-1000.

Contact Information

Primary practice address
2121 E Harmony Rd Ste 100 Fort Collins CO 80528-3400
Phone: (970) 221-1000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology 207RC0001X DR.0053902 Colorado
Allopathic & Osteopathic Physicians / Clinical Cardiac Electrophysiology 207RC0001X 27958 Nebraska
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 235720 Massachusetts
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X DR.0053902 Colorado
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X DR.0053902 Colorado

Profile Details

NPI number 1316110208
LBN Legal business name Ellis, Ethan R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2008
Last updated Mar 28th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316110208 NPPES
Colorado MEDICAID 87529351

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