Individual
ELLIS KEITH GARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12880 COMMODITY PL, CARE OF UNITED SURGICAL ASSISTANTS, INC., TAMPA, FL 33626-3101
(877) 872-5788
(866) 698-7272
Mailing address
PO BOX 21686, CARE OF UNITED SURGICAL ASSISTANTS, INC., TAMPA, FL 33622-1686
(877) 872-5788
(866) 698-7272
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA0001998
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00040948
RAILROAD MEDICARE PROVIDE
FL
Enumeration date
08/30/2005
Last updated
07/09/2007
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