Individual
MR. ELLIS FRANKLIN FORT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
502 PALMETTO ST, NEW SMYRNA BEACH, FL 32168
(386) 957-1854
(386) 878-4967
Mailing address
502 PALMETTO ST, NEW SMYRNA BEACH, FL 32168-7325
(869) 571-8543
(386) 878-4967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9105205
FL
Other
Enumeration date
08/16/2010
Last updated
05/30/2019
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