# JONATHAN ELLEN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851848360
- **Authorized official:** JONATHAN ELLEN MD (OWNER/MANAGER)
- **Authorized official phone:** (575) 521-4600

## Contact information

- **Practice address:** 4441 E LOHMAN AVE, LAS CRUCES, NM 88011-8267
- **Practice address phone:** (901) 484-2052
- **Mailing address:** PO BOX 1000 DEPT 0420, MEMPHIS, TN 38148-0420
- **Mailing address phone:** (901) 821-0338
- **Mailing address fax:** (901) 821-0341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 10/24/2024