Healthcare Provider Details

I. General information

NPI: 1740695949
Provider Name (Legal Business Name): ELIZABETH EWING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8738 ORTEGA PARK DR
NAVARRE FL
32566-4139
US

IV. Provider business mailing address

4951 GRANDE DR
PENSACOLA FL
32504-8965
US

V. Phone/Fax

Practice location:
  • Phone: 850-934-5776
  • Fax: 850-710-7140
Mailing address:
  • Phone: 850-473-0100
  • Fax: 850-473-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME153130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: