Individual
RYAN SCOTT ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
505 FAIRBURN RD SW STE 100, ATLANTA, GA 30331-2012
(404) 618-6077
(801) 253-6888
Mailing address
9980 S 300 W STE 300, SANDY, UT 84070-3654
(801) 273-0001
(801) 253-6888
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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