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Individual

MR. JACOB ELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
7808 ULTRA DR, COLORADO SPRINGS, CO 80920-8058
(719) 209-5569
Mailing address
7808 ULTRA DR, COLORADO SPRINGS, CO 80920-8058
(719) 209-5569

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
1234
CO

Other

Enumeration date
07/31/2025
Last updated
07/31/2025
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