Individual
DR. JOHN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4422 THIRD AVE, BRONX, NY 10457
(718) 960-9000
Mailing address
6751 EAGLE RIDGE BLVD, LAKELAND, FL 33813-5636
(727) 417-6369
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
160849
MT
207P00000X
Emergency Medicine Physician
Primary
22891
CA
207P00000X
Emergency Medicine Physician
OS15644
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2014
Last updated
11/24/2025
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