Organization
LYNNE M. ELLIS, MD,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNNE M ELLIS MD (PRESIDENT)
(727) 822-5393
Entity
Organization
Contact information
Practice address
1111 7TH AVE N STE 103, ST PETERSBURG, FL 33705-1348
(727) 822-5393
Mailing address
1111 7TH AVE N STE 103, ST PETERSBURG, FL 33705-1348
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
46897
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262210600
—
FL
Enumeration date
01/10/2007
Last updated
09/25/2012
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