Robert G Ellison Jr., MD
Individual provider Active NPI Vascular Surgery Physician · Jacksonville, FL
NPI 1477571008 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477571008
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- License
- ME39556 (FL)
- Practice address
- 836 Prudential Dr
Suite 1405
Jacksonville, FL 32207-8334 - Phone
- (904) 388-7521
- Fax
- (904) 388-3541
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME39556 | FL | MD | Vascular Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | ME39556 | FL | Yes |
Addresses
Primary practice location
836 Prudential Dr
Suite 1405
Jacksonville, FL 32207-8334
Mailing address
836 Prudential Dr
Suite 1405
Jacksonville, FL 32207-8334
Phone (904) 388-7521
Other providers in Jacksonville, FL
- Michelle Ellis
- Nancy Ellis
- Steven Maurice Ellis II
- Tanace Ellis
- Troy Townsend Ellis
- Eloisa Anne Ello-Esma
- Marylou V Ello
- Joseph Ellow
- Tasha Ellsberry
- Donald Dean Ellsworth
All providers in Jacksonville, FL · Vascular Surgery Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.