Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME0064771 | FL |
NPI | 1003808551 |
---|---|
Provider Name | Paul Stribling Ellison JR. |
First Address | Key Largo, FL 33037-2526 |
Second Address | Key Largo, FL 33037-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379646900 | (05) | FL |
F67907 | (02) |