Individual
DR. BRYAN JON ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10506 MONTGOMERY RD STE 304, MONTGOMERY, OH 45242-4400
(513) 853-9000
(513) 984-2692
Mailing address
1270 SOLUTIONS CENTER, PO BOX 771270, CHICAGO, IL 60677-1002
(513) 542-6898
(513) 542-7972
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34005984
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2192050
—
OH
Enumeration date
09/27/2006
Last updated
08/21/2023
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