Individual
JEFFREY LEE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 VFW PKWY # 112, WEST ROXBURY, MA 02132-4927
(857) 203-6205
Mailing address
1400 VFW PKWY # 112, WEST ROXBURY, MA 02132-4927
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036.160253
IL
208800000X
Urology Physician
MT212656
PA
390200000X
Student in an Organized Health Care Education/Training Program
MT212656
PA
Other
Enumeration date
06/05/2017
Last updated
11/30/2025
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