Clay Ellenwood PA-C
Medical Physician Assistant in Mentor, OH(View on Map)
Full Name
Clay Ellenwood PA-C
NPI Number
1588134456
NPI Type
Individual Provider
Gender
Male
Enumeration Date
12/04/2018
Specialties
(Taxonomies)Licenses
State
Michigan
Ohio
License Number
5601008913
50.006802RX
Contact
Information
Purpose
Mailing
Location
Address
7232 JUSTIN WAY
7232 JUSTIN WAY
City
Mentor
Mentor
State
OH
OH
Postal Code
44060-4881
44060-4881
Country
US
US
Telephone Number
(440) 578-8200
(440) 578-8200
Identifiers
Identifier
5601008913
Identifier State
MI
Identifier Issuer
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/19/2022