Individual
DR. JOHN BRYAN ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
188550-1205
UT
208800000X
Urology Physician
15297
NV
208800000X
Urology Physician
Primary
77080
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005575530
HUMANA
UT
01
—
107011798101
IHC
UT
01
—
18855012000001
BC BS
UT
01
—
340020123
RR MEDICARE
UT
01
—
6411882
CIGNA
UT
01
—
68471
PEHP
UT
01
—
751575
DMBA
UT
01
—
870562879ELL
EMIA
UT
01
—
QM0000076522
ALTIUS
UT
01
—
V108245
MEDICARE ID FOR NEVADA PRACTICE LOCATION
NV
Enumeration date
06/16/2005
Last updated
04/30/2025
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