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NPI Code Detail

MEDICARE: DR. GEORGE FREDERICK ELLIS MD

MEDICARE: DR. GEORGE FREDERICK ELLIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician163161NY
2208800000XUrology PhysicianME49437FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ME49437OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1033144597
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE FREDERICK ELLIS MD
Provider Business Mailing Address
First Line : 571 SAINT JOSEPHS BLVD
Second Line : FL 2
City : ELMIRA
State : NY
Zip : 14901-3230
Country : US
Telephone Number : 607-271-2050
Fax Number :
Provider Business Practice Location Address
First Line : 89 W COPELAND DR
Second Line :
City : ORLANDO
State : FL
Zip : 32806-2002
Country : US
Telephone Number : 321-842-6910
Fax Number : 321-843-5998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 10/25/2018

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Directions to “ DR. GEORGE FREDERICK ELLIS MD” Practice Location

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