Individual
JOHN ELLIS AGENS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4449 MEANDERING WAY, FSU SENIORHEALTH AT WOK, TALLAHASSEE, FL 32308-5740
(850) 644-1543
(850) 645-0577
Mailing address
PO BOX 3064300, 1115 WEST CALL STREET, SUITE 1121-C, TALLAHASSEE, FL 32306-4300
(850) 645-9350
(850) 645-0577
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME 87099
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME87099
FL
Other
Enumeration date
04/26/2006
Last updated
01/13/2017
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