Individual
DR. JASON MARK ELLWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6905 HARRIS AVENUE, KAILUA, HI 96734
(850) 505-6601
Mailing address
6905 HARRIS AVENUE, KAILUA, HI 96734
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0102206240
VA
208D00000X
General Practice Physician
Primary
0102206240
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/17/2019
Last updated
08/18/2023
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