Individual
ETHAN R ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 E HARMONY RD, STE 100, FORT COLLINS, CO 80528-3400
(970) 221-1000
Mailing address
2121 E HARMONY RD, STE 100, FORT COLLINS, CO 80528-3400
(970) 221-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
235720
MA
207R00000X
Internal Medicine Physician
DR.0053902
CO
207RC0000X
Cardiovascular Disease Physician
DR.0053902
CO
207RC0001X
Clinical Cardiac Electrophysiology Physician
27958
NE
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
DR.0053902
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87529351
—
CO
Enumeration date
04/11/2008
Last updated
03/28/2016
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