Individual
JABON L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 257-8222
(915) 742-2653
Mailing address
1008 S SPRING AVE, SAINT LOUIS, MO 63110-2520
(314) 257-8222
(314) 577-8019
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
2020016505
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2012
Last updated
12/02/2024
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