Individual provider · NPI-1

Andrew R Ellsworth, MD

Family Medicine · Brookings, SD

NPI number1568690758
StatusActive
Last updated in NPPESSep 19, 2012

Details

NPI
1568690758
Entity type
Individual (NPI-1)
Name
Andrew R Ellsworth
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 25, 2009
Last updated
Sep 19, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine8575SDYes

Practice location

400 22nd Ave
Brookings, SD 57006-2497

Phone 605-697-9500 · Fax 605-697-6939

Mailing address

400 22nd Ave
Brookings, SD 57006-2497

Phone 605-697-9500 · Fax 605-697-6939

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