Robert G Ellison Jr., MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

ME39556 Issued in 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

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Robert G Ellison Jr MD P a

  dba Robert G Ellison Jr MD

  • Specialist
  • Jacksonville, FL
  • NPI 1699979203
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477571008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 PRUDENTIAL DR",
            "address_2": "SUITE 1405",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078334",
            "telephone_number": "904-388-7521",
            "fax_number": "904-388-3541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 PRUDENTIAL DR",
            "address_2": "SUITE 1405",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078334",
            "telephone_number": "904-388-7521",
            "fax_number": "904-388-3541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "ROBERT",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME39556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Ellis
• Nancy Ellis, RRT
• Steven Maurice Ellis II
• Tanace Ellis
• Troy Townsend Ellis, PA-C
• Eloisa Anne Ello-Esma, ARNP, FNP-BC
• Marylou V Ello, ARNP
• Joseph Ellow
• Tasha Ellsberry, APRN, FNP, PMHNP-BC
• Donald Dean Ellsworth, ARNP-BC

• Vascular Surgery Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.