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Individual
CLAYTON TYLER ELLIS
Active
Individual
CLAYTON TYLER ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
TP364
KY
390200000X
Student in an Organized Health Care Education/Training Program
173420
NC
Other
Enumeration date
05/31/2011
Last updated
05/22/2019
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