Individual
DR. PAMELA I ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13535 NEMOURS PKWY, ORLANDO, FL 32827-7402
(407) 567-4000
(407) 567-5924
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4127
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
150422
MA
208800000X
Urology Physician
MD11894
RI
2088P0231X
Pediatric Urology Physician
150422
MA
2088P0231X
Pediatric Urology Physician
Primary
ME129642
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018993600
—
FL
01
—
31017
BLUE SHIELD
RI
05
—
3158667
—
MA
05
—
PE45993
—
RI
Enumeration date
11/05/2005
Last updated
01/13/2018
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