Individual
CLAYTON TYLER ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
ULP COLORECTAL SURGERY, 401 EAST CHESTNUT STREET, #710, LOUISVILLE, KY 40202-5707
(502) 583-8303
(502) 588-9506
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
(502) 588-0326
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
TP364
KY
390200000X
Student in an Organized Health Care Education/Training Program
173420
NC
Other
Enumeration date
05/31/2011
Last updated
05/22/2019
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