Individual
MATTHEW MCKINLEY ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
613 23RD ST STE G30, ASHLAND, KY 41101-2881
(606) 327-0036
(606) 326-1159
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00426
KY
213E00000X
Podiatrist
36.003921
OH
213ES0131X
Foot Surgery Podiatrist
00426
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100351750
—
KY
Enumeration date
05/03/2012
Last updated
08/12/2020
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