Individual
JOHN A ELLZEY
Active
Individual
JOHN A ELLZEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36589
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122829
—
MS
05
—
142994001
—
AR
05
—
209040203
—
MO
05
—
3883156
—
TN
01
—
4065404
BCBS
TN
01
—
5L864
BCBS
AR
01
—
P00032804
RR MEDICARE
TN
01
—
P00294088
RR MEDICARE
MS
Enumeration date
08/19/2006
Last updated
01/28/2022
Update your record
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