Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 163161 | NY |
N | 208800000X | Urologist | ME49437 | FL |
NPI | 1033144597 |
---|---|
Provider Name | Dr. George Frederick Ellis |
First Address | Elmira, NY 14901-3230 |
Second Address | Orlando, FL 32806-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 25/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273075800 | (05) | FL |
ME49437 | MEDICAL LICENSE (01) | FL |