NPI 1407040488 · live from the CMS NPI Registry
Jeffrey Cowan Ellison, MD
Internal Medicine, Gastroenterology in Fayetteville, AR. National Provider Identifier 1407040488, active.
NPI record
| NPI | 1407040488 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine, Gastroenterology 207RG0100X |
| Practice location | 3344 N Futrall Dr, Fayetteville, AR 72703 |
| Practice phone | 479-521-8200 |
| Mailing address | Po Box 1523, Fayetteville, AR 72702 |
| Enumerated | September 1, 2007 |
| Last updated | November 2, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine, Gastroenterology primary | 207RG0100X | E-6356 (AR) |
| Internal Medicine | 207R00000X | 25527 (AR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.