Provider Demographics
NPI:1932237039
Name:ELLERHORST, JEFFREY AARON (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:AARON
Last Name:ELLERHORST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9415
Mailing Address - Country:US
Mailing Address - Phone:330-527-4852
Mailing Address - Fax:330-527-4866
Practice Address - Street 1:1 MEMORY LN STE 200
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9415
Practice Address - Country:US
Practice Address - Phone:330-527-4852
Practice Address - Fax:330-527-4866
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.008028207Q00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program