Individual
DR. JEFFREY L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 MEDICAL CIR, MOREHEAD, KY 40351-1179
(606) 783-6732
(606) 783-6488
Mailing address
222 MEDICAL CIR, MOREHEAD, KY 40351-1179
(606) 783-6732
(606) 783-6488
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
26605
KY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
26605
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000072449
BC PHYSICIAN GROUP NUMBER
KY
01
—
000000186695
BC INDIVIDUAL NUMBER
KY
05
—
64266059
—
KY
05
—
65906844
—
KY
Enumeration date
09/12/2006
Last updated
07/13/2020
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