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General NPI Number Information
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NPI Number | 1114345212
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Entity Type | Individual
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Provider Name | ELLEN MITCHELL EZELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 11/11/2023
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Provider Practice Location Address
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Address Line | 701 W MORSE BLVD
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City | WINTER PARK
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State | FL
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Zip | 32789-3749
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Country | US
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Telephone | 407-629-5555
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Fax | 407-629-4884
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Provider Business Mailing Address
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Address Line | 701 W MORSE BLVD
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City | WINTER PARK
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State | FL
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Zip | 32789-3749
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Country | US
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Telephone | 407-629-5555
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Fax | 407-629-4884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME145344
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License Number State | FL
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