| Doctor Name: | RYAN ELLSWORTH |
| NPI Number: | 1104130574 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 8400193-0501 |
| Business Practice Address: | 4019 W 12600 S Suite 120 Riverton, UT - 840967401 |
| Business Phone Number: | 8012536886 |
| Business Fax Number: | 8012536888 |
| Mailing Address: | 169 W 1435 S, OREM |
| State: | UT |
| Postal Code: | 840587469 |
| Phone Number: | 8012536886 |
| Fax Number: | 8012536888 |
| NPI Enumeration Date: | 07/28/2010 |
| NPI Last Update Date: | 08/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 8400193-0501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |