Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD22134 | OR |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35.089720 | OH |
NPI | 1124036645 |
---|---|
Provider Name | Thomas James Ellis |
First Address | Upper Arlington, OH 43220-2246 |
Second Address | Upper Arlington, OH 43220-2246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 29/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134348 | (05) | OR |
2748067 | (05) | OH |
G53903 | (02) |