Organization
ROBERT G ELLISON JR MD P A
Active
Other names
Robert G Ellison Jr MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT G ELLISON JR. MD (OWNER)
(904) 388-7521
Entity
Organization
Contact information
Practice address
836 PRUDENTIAL DR, SUITE 1405, JACKSONVILLE, FL 32207-8334
(904) 388-7521
Mailing address
836 PRUDENTIAL DR, SUITE 1405, JACKSONVILLE, FL 32207-8334
(904) 388-7521
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME39556
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0434438800
—
FL
Enumeration date
06/14/2007
Last updated
08/10/2007
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