Individual
CLARENCE V ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12790 W ALAMEDA PKWY STE A, LAKEWOOD, CO 80228-2850
(303) 403-6350
(303) 403-6372
Mailing address
2420 W 26TH AVE STE 400D, DENVER, CO 80211-5357
(303) 988-4870
(303) 984-1114
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33692
CO
2083X0100X
Occupational Medicine Physician
33692
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0801103606
MEDICARE RAILROAD
—
05
—
61572578
—
CO
Enumeration date
06/13/2006
Last updated
01/25/2012
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