# MATTHEW S ELLIS MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780703561
- **Authorized official:** DR. MATTHEW STEWART ELLIS MD (PRESIDENT)
- **Authorized official phone:** (352) 333-5911

## Contact information

- **Practice address:** 6400 W NEWBERRY RD, SUITE 104, GAINESVILLE, FL 32605
- **Practice address phone:** (352) 333-5911
- **Practice address fax:** (353) 333-4684
- **Mailing address:** PO BOX 3123, ST AUGUSTINE, FL 32085-3123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | ME96520 | FL | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 08/05/2020