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Individual

RYAN SCOTT ELLSWORTH

Active
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Individual

RYAN SCOTT ELLSWORTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
2109
NV
213E00000X
Podiatrist
E5797
CA
213E00000X
Podiatrist
PO4406
FL
213E00000X
Podiatrist
POD001473
GA
213EP1101X
Primary Podiatric Medicine Podiatrist
8400193-0501
UT
213ER0200X
Radiology Podiatrist
8400193-0501
UT
213ES0000X
Sports Medicine Podiatrist
8400193-0501
UT
213ES0103X
Foot & Ankle Surgery Podiatrist
8400193-0501
UT
213ES0131X
Foot Surgery Podiatrist
Primary
8400193-0501
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1003111
UT
01
2109
NV DPM LICENSE
NV
01
7672880001
DME
UT
01
8400193-0501
UT DPM LICENSE
UT
01
E5797
CA DPM LICENSE
CA
01
PO4406
FL DPM LICENSE
FL
01
POD001473
GA DPM LICENSE
GA
Enumeration date
07/28/2010
Last updated
06/17/2024
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