Healthcare Provider Details

I. General information

NPI: 1104092972
Provider Name (Legal Business Name): NEIL JAMES ELLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6449 102ND AVE N
PINELLAS PARK FL
33782-3027
US

IV. Provider business mailing address

501 N REO ST STE 100
TAMPA FL
33609-1012
US

V. Phone/Fax

Practice location:
  • Phone: 727-350-0450
  • Fax:
Mailing address:
  • Phone: 813-549-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME115797
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME115797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: