Individual
JOHN I ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 COLCHESTER AVE, MCHV CAMPUS - ED, BURLINGTON, VT 05401-1473
(802) 847-3982
Mailing address
111 COLCHESTER AVE, MCHV CAMPUS - ED, BURLINGTON, VT 05401-1473
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
042.0012393
VT
207P00000X
Emergency Medicine Physician
10994
NV
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
10994
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506833
—
NV
01
—
CC8994
BC/BS
NV
01
—
P00232612
RAILROAD MEDICARE
NV
Enumeration date
03/21/2006
Last updated
07/19/2013
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