Jack Ellis I, PA-C

NPI #1346962982 in Powell, Ohio

Provider Information

NPI Number: 1346962982
Entity Type: Individual
Name: Jack Ellis I, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Sep 12, 2022
Last Updated: Nov 21, 2022

Practice Location

Address: 4141 N HAMPTON DR STE 200
City: Powell
State: Ohio
ZIP Code: 43065-7062
Phone: (614) 764-0200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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