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Individual

DAVID J ELLINGSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
3310 WATERMAN WAY, TAVARES, FL 32778-5250
(352) 343-1216
(352) 343-1582
Mailing address
PO BOX 935921, ATLANTA, GA 31193-5921

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9102690
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
291796300
FL
Enumeration date
07/08/2005
Last updated
06/28/2024
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